STARI

Tick species that transmit STARI: Lone Star tick (Amblyomma americanum)

What is STARI?

Southern Tick Associated Rash Illness (STARI), also known as Masters disease, occurs after the bite of the lone star tick, Amblyomma americanum. The disease is thought to be caused by the bacterium Borrelia lonestari. However, this hypothesis is based on a single case of B. lonestari infection in a STARI patient. No other report has confirmed B. lonestari infection in a suspected STARI patient. Borrelia burgdorferi (the causative agent of Lyme disease) has been ruled out as the cause of STARI because lone star ticks do not transmit B. burgdorferi.
Early STARI symptoms are similar to symptoms of early Lyme disease (LD). A skin lesion (or rash) that looks like a Lyme disease erythema migrans (EM) appears at the site of the tick bite. Treatment with an antibiotic regimen similar to that used for LD helps resolve STARI. In some patients, STARI resolves on its own without antibiotic treatment.

Where is STARI Prevalent?

The lone star tick is found in southern states as well as along the East coast up to Maine (see map below). Cases of STARI are most common in the south, although cases have been reported as far north as New Jersey. It is highly likely that cases of STARI have been mistaken for LD due to similarities in symptomology.
U.S. Distribution of Lone Star Ticks

Image Source: The Centers of Disease control and Prevention, redrawn and updated from Hair and Bowman, 1986.

Symptoms

STARI symptoms are similar to early LD symptoms. STARI lesions often appear at the site of the tick bite. The most common symptom reported by STARI patients with skin lesions is fatigue.
A study in Clinical Infectious Diseases reports that there are some very subtle differences between STARI and LD. STARI patients with skin lesions are less likely to report symptoms that commonly accompany LD. STARI lesions are typically smaller in diameter and tend to have central clearing (bull's-eye appearance) more often than EM lesions.

Diagnosis

Serologic testing for LD antibodies in STARI patients is not helpful because STARI is not caused by B. burgdorferi (the causative agent of LD). The Centers for Disease Control and Prevention recommends that patients with an expanding rash and recent history of exposure to the lone star tick see a physician.

Treatment

Patients suspected of having STARI seem to respond well to a treatment regimen similar to that used for LD (see Table of Recommended Antibiotics and Dosages).

 American Lyme Disease Foundation. (2011, April 28). American Lyme Disease Foundation. Retrieved July 22, 2013, from http://www.aldf.com/stari.shtml

Naegleria fowleri

Left: EM image of Naegleria fowleri in its cyst stage. Center: EM image of Naegleria fowleri in its ameboid trophozoite stage. Right: EM image of Naegleria fowleri in its flagellated stage. Credit: DPDx and GS Visvesvara.

Naegleria fowleri (commonly referred to as the "brain-eating amoeba" or "brain-eating ameba"), is a free-living microscopic ameba*, (single-celled living organism). It can cause a rare** and devastating infection of the brain called primary amebic meningoencephalitis (PAM). The ameba is commonly found in warm freshwater (e.g. lakes, rivers, and hot springs) and soil. Naegleria fowleri usually infects people when contaminated water enters the body through the nose. Once the ameba enters the nose, it travels to the brain where it causes PAM, which is usually fatal. Infection typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. In very rare instances, Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated and contaminated tapwater) enters the nose ^{1, 2, 3}. (CDC, 2013).

 References

1. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.
2. Visvesvara GS. Free-living amebae as opportunistic agents of human disease.  [PDF - 13 pages] J Neuroparasitol. 2010;1.
3. Marciano-Cabral F, Cabral G. The immune response to Naegleria fowleri amebae and pathogenesis of infection. FEMS Immunol Med Microbiol. 2007;51:243-59.
4.  CDC - Naegleria fowleri - Primary Amebic Meningoencephalitis (PAM). (2013, May 30). Centers for Disease Control and Prevention. Retrieved July 22, 2013, from http://www.cdc.gov/parasites/naegleria/

Hepatitis B

It is ironic that one of the diseases of choice to blog about is Hepatitis B.  This is a disease I wanted to learn more about due to the fact that yesterday a man came into the health department, where I currently intern, wanting a vaccination for Hepatitis B.  This vaccination is also known as Hep B.  He stated that he fit the criteria to receive the vaccine at a reduced price, being that he was a former drug user.  This is actually how he became infected.  After the patient left I asked my preceptor if Hepatitis B was a STD, she said yes.  I was little shocked that I did not know this information and I am happy that this blog will give me the chance to do a little more research. 

Hepatitis B is a virus which attacks the liver, causing both acute and chronic diseases.  It is generally contracted from the transmission of blood and bodily fluids, which is why it is classified as a STD.  Globally, about two billion people have been affected worldwide and roughly 600,000 die from complications from Hepatitis B annually.  Drug users, health workers, and sex workers are at the highest risk for contracting the virus.  Hepatitis B can survive outside the body for about seven days, and can still be contracted if someone who is not vaccinated comes into contact with the virus.  The symptoms include “yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain” (WHO, 2013).  The majority of the people affected with Hepatitis B will recover and be completely rid of the virus in a period of about six months.  It is more prevalent in countries in Africa and East Asia, where the majority of the illnesses occur in childhood.  “High rates of chronic infections are also found in the Amazon and the southern parts of eastern and central Europe” (WHO, 2013). 

Hepatitis B. (n.d.). World Health Organization. Retrieved July 18, 2013, from http://www.who.int/mediacentre/factsheets/fs204/en/index.html

"Rachel Carson reponsible for the death of millions of African children"

As a parent you are responsible for the health of your child.  You know what environment they are in and how to properly raise them, hopefully, better than anyone else.  Parents must make whatever choice they feel is needed to protect their children physically, mentally, health wise, etc.  This being said, I feel that Rachel Carson raising awareness about the harms of DDT does not make her responsible for the deaths of African children.  The after effects of inhaling DDT over the years may prove to be just as harmful as effects of contracting malaria.  The "National Institute of Environmental Health Sciences, said the chemical might have increased infant deaths" (Milloy, 2011).  DDT is a chemical, and this point, is why awareness is actually needed.  People tend not realize that when they so call better their environment, they are actually hurting not only their environment even more, but their health as well in the process. 

Milloy, S. (2011, May 19). DDT causes diabetes, breast cancer and infant deaths? | JunkScience.com. JunkScience.com | All the Junk That's Fit to Debunk. Retrieved July 18, 2013, from http://junkscience.com/2011/05/19/ddt-causes-diabetes/