North Carolina STARI Introduction Barbara Johnson, PhD –[email protected]@cdc.gov –CDC, Foothills...
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Transcript of North Carolina STARI Introduction Barbara Johnson, PhD –[email protected]@cdc.gov –CDC, Foothills...
North Carolina STARI Introduction
Barbara Johnson, PhD– [email protected]
– CDC, Foothills Campus, 3150 Rampart Road, Fort Collins, CO 80521
– Phone: 970-221-6463– Fax: 970-225-4257
Southern Tick-Associated Rash Illness (STARI)
Estimated Distribution of A. americanum
Erythema migrans-like rash after Amblyomma americanum bite
19 x 11 cm rash area
A. americanum adult female
Why we need your help
• Clinical reasons– Cause unknown– No laboratory diagnostic test– No scientific basis for treatment– Incidence of serious sequelae unknown
• Public health reasons– Confused with Lyme disease
• EM is part of the case definition for Ld• ~4000 cases of Ld reported from southern states
– Impacts understanding of performance of diagnostic tests (and vaccine efficacy)
1 dot placed randomly within county of residence for each reported case
Reported Cases of Lyme Disease -- United States, 2004
Wormser et al. 2005 CID
STARI in Missouri
Peak incidence: May - June
Occurs: April - October
Tick bite to rash onset: 6 +/- 4 days
Symptoms (n=21)
19 % fatigue
14 % fever or chills
14 % muscle pain
10% paresthesias
5% joint pain
5% cough
Multiple EMs: 5%
Central clearing 75%
8.3 +/- 2.2 cm
STARI Patients States of Probable ExposureTo Unknown Agent
Patients (n=34) donated paired serum samples, a fresh skin biopsy specimen, and/or a fixed skin sample.
Patient’s skin contained B. lonestari DNA
Enrolled patients
Patient 4 (Maryland): Moderate superficial perivascular infiltrates;
predominantly mononuclear inflammatory cells
10x10x 40x
All images: H & E stains
Patient 5 (Tennessee): Panniculitis (inflammation of subcutaneous adipose tissue; mononuclear infiltrates between adipocytes
10x 40x
10x 40x
Patient 16 (South Carolina and/or Georgia exposure): Diffuse mixed inflammatory cell infiltrates in the dermis; abundant eosinophils (bright red cells)
Patient 19 (South Carolina): Mild perivascular infiltrates (superficial and deep); predominantly mononuclear inflammatory cells
10x 40x
Reference image:
Erythema migrans due to Borrelia burgdorferi infection
Moderate to severe superficial and deep mononuclear infiltrate, mostly perivascular.
Infiltrate mainly lymphocytes and histiocytes with some plasma cells.
(R. MÜllegger, used with permission)
Distinctive features of STARI images:
No findings common to all samples. Large number of eosinophils, involvement of subcutaneous fat, collagen changes, and absence of plasma cells.