# Identification of the agent of Southern Tick Associated Rash Illness

> **NIH NIH R21** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2022 · $202,500

## Abstract

ABSTRACT
Southern Tick Associated Rash Illness (STARI) is febrile illness that occurs following bites of Amblyomma
americanum ticks. Although it was initially reported over two decades ago, the agent of STARI remains
unknown, and no diagnostic tests are available. The recent northward expansion of A. americanum has
brought these ticks into areas highly endemic for Lyme disease. The primary indicator of STARI is an
expanding rash around the tick bite, that can be misdiagnosed as an erythema migrans. The similarity of the
rash and the accompanying non-specific symptoms presents challenges for physicians. In addition, there is a
lack of defined treatment protocols for STARI. While it has been suggested that antibiotic treatment may have
utility, this has not been clearly demonstrated. The identification of the STARI agent would have profound
effects on the ability to diagnose and treat this syndrome, as well as clarify the epidemiology of this illness. In
this proposal, we will employ state of the art molecular and serologic tools to identify the agent of STARI. We
will identify unique microbial sequences through comprehensive metagenomic sequencing of skin biopsies
taken from within the STARI rash and attached ticks. We will then develop serologic assays to demonstrate
exposure to this agent in sera from STARI patients. This work will determine the microbial origin of STARI and
enhance opportunities for accurate diagnostics and therapy.

## Key facts

- **NIH application ID:** 10364660
- **Project number:** 5R21AI156475-02
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Rafal Tokarz
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $202,500
- **Award type:** 5
- **Project period:** 2021-03-08 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10364660

## Citation

> US National Institutes of Health, RePORTER application 10364660, Identification of the agent of Southern Tick Associated Rash Illness (5R21AI156475-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10364660. Licensed CC0.

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