Physician-Diagnosed Erythema Migrans and Erythema Migrans–like Rashes Following Lone Star Tick Bites

Masters, Edwin J.; Granter, Scott R.; Duray, Paul H.; Cordes, Paul Josef

doi:10.1001/archderm.134.8.955

Cited by 91 publications

(58 citation statements)

References 28 publications

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“…A similar zoonosis called Lyme disease-like Illness or Masters' Disease, also known as Southern Tick-Associated Rash Illness (STARI) has been reported in the south of USA 27 , caused by B. lonestari, which is a spirochete uncultivable in BSK medium and genetically similar to B. theileri, found in cattle. STARI is transmitted by the Amblyomma americanum tick, and the clinical picture is characterized by the appearance of erythema migrans (EM), without jeopardy of internal organs.…”

Section: Introductionmentioning

confidence: 96%

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas"

Gouveia

Alves

Mantovani

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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SUMMARYThe aim of this study was to evaluate the epidemiological, clinical and laboratorial profile of patients with Baggio-Yoshinari Syndrome (BYS), who underwent internment at the Instituto de Infectologia Emilio Ribas in São Paulo, Brazil, during the period from July 1990 to July 2006. BYS is a new Brazilian tick-borne disease caused by Borrelia burgdorferi sensu lato microorganisms that resembles features of Lyme disease (LD), except for its epidemiological, clinical and laboratorial particularities. From 60 patients' records with positive serology to B. burgdorferi done by ELISA and Western-blotting methods, 19 cases were diagnosed as having BYS, according to criteria adopted at LIM-17 HCFMUSP, the Brazilian Reference Laboratory for the research of BYS. The other 41 remaining patients displayed miscellaneous infections or auto-immune processes. The beginning of symptoms in BYS group varied from one day to six years, from the onset of the disease. Four of 19 patients were included in acute disease stage, and 15 in latent. General unspecific symptoms were identified in almost all cases, with high frequencies of fever (78.9%) and lymphadenomegaly (36.8%). Six patients had skin lesions (31.5%); six arthralgia or arthritis (31.5%) and eight neurological symptoms (42%). Interestingly, two patients showed antibodies directed to B. burgdorferi exclusively in cerebrospinal fluid. Since BYS is a new emergent Brazilian zoonosis and its diagnosis is sometimes complex, all the new knowledge about BYS must be scattered to Brazilian Medical specialists, aiming to teach them how to diagnose this amazing tick-borne disease and to avoid its progression to chronic irreversible sequels.

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Section: Introductionmentioning

confidence: 96%

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas"

Gouveia

Alves

Mantovani

et al. 2010

Rev. Inst. Med. trop. S. Paulo

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“…This disease is alternatively referred to as southern tick-associated rash illness (STARI), Master's disease, or southern Lyme disease (23,30). A. americanum has been shown to be an incompetent vector for B. burgdorferi, and serologic testing of STARI patients does not support a diagnosis of classic Lyme disease despite microscopic evidence of spirochetes in biopsy samples of affected skin, leading researchers to speculate that another Borrelia sp.…”

mentioning

confidence: 99%

First Culture Isolation of Borrelia lonestari , Putative Agent of Southern Tick-Associated Rash Illness

Varela¹,

Luttrell

Howerth³

et al. 2004

J Clin Microbiol

108

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Southern tick-associated rash illness (STARI) is a Lyme disease-like infection described in patients in the southeastern and south-central United States, where classic Lyme disease is relatively rare. STARI develops following the bite of a lone star tick (Amblyomma americanum) and is thought to be caused by infection with an "uncultivable" spirochete tentatively named Borrelia lonestari. In this study, wild lone star ticks collected from an area where B. lonestari is endemic were cocultured in an established embryonic tick cell line (ISE6). The cultures were examined by dark-field microscopy for evidence of infection, and spirochete identity and morphology were evaluated by flagellin B and 16S rRNA gene sequence, by reaction to Borrelia-wide and B. burgdorferi-specific monoclonal antibodies, and by electron microscopy. Live spirochetes were first visualized in primary culture of A. americanum ticks by dark-field microscopy 14 days after the cell culture was inoculated. The sequences of the flagellin B and 16S rRNA genes of cultured spirochetes were consistent with previously reported sequences of B. lonestari. The cultured spirochetes reacted with a Borrelia-wide flagellin antibody, but did not react with an OspA antibody specific to B. burgdorferi, by indirect fluorescent antibody testing. Electron microscopy demonstrated organisms that were free and associated with ISE6 cells, with characteristic Borrelia sp. morphology. This study describes the first successful isolation of B. lonestari in culture, providing a much needed source of organisms for the development of diagnostic assays and forming a basis for future studies investigating the role of the organism as a human disease agent.

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“…However, a Lyme disease-like illness that develops following the bite of the Lone Star tick, Amblyomma americanum, has been described (2,7,12,17,27,28). Individuals affected with this illness, termed "southern tick-associated rash illness" (STARI), commonly develop a localized expanding circular skin rash (erythema migrans) at the site of the tick bite similar to that seen with classic Lyme disease.…”

mentioning

confidence: 99%

Detection of Borrelia lonestari , Putative Agent of Southern Tick-Associated Rash Illness, in White-Tailed Deer ( Odocoileus virginianus ) from the Southeastern United States

Moore¹,

Varela²,

Yabsley

et al. 2003

J Clin Microbiol

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Physician-Diagnosed Erythema Migrans and Erythema Migrans–like Rashes Following Lone Star Tick Bites

Cited by 91 publications

References 28 publications

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas"

Profile of patients with Baggio-Yoshinari Syndrome admitted at "Instituto de Infectologia Emilio Ribas"

First Culture Isolation of Borrelia lonestari , Putative Agent of Southern Tick-Associated Rash Illness

Detection of Borrelia lonestari , Putative Agent of Southern Tick-Associated Rash Illness, in White-Tailed Deer ( Odocoileus virginianus ) from the Southeastern United States

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