Everyone has heard of Lyme Disease but have you heard of Southern Tick Associated Rash Illness, or STARI? How about Alphal-gal Syndrome?
The lone star tick is the most predominant tick in Georgia.
Recall Lyme disease
Let's start by reviewing Lyme disease. This infection is caused by a spirochete bacteria, Borrelia burgdorferi, and is transmitted by a bite from an infected blacklegged tick or deer tick. In most public health literature, you will see the name blacklegged tick instead of deer tick, which is an identifying description as the legs are black while the body is reddish-brown. Lyme disease occurs in all 50 states as ticks feast not only on mice and deer but also on migrating birds.
About spirochetes: All borrelia species are spirochetes, which are spiral-shaped and have the ability to uncorkscrew and act like worms burrowing into tissues. They have a flagella or tail that helps with motility. Another spirochete is Treponema pallidum, which causes syphilis. Consider the similarities between Lyme disease and syphilis...both have multiple stages of the disease; both have varied presentations, making them masqueraders, which can result in a missed diagnosis; both bacteria burrow into the CNS (brain); both bacteria burrow into other tissues (heart, skin, joints, blood vessels), both infections may either stop progressing and/or appear to resolve, both if left untreated may cause permanent disease that may be treated but cannot be cured.
When bitten by a tick carrying B. Burgdorferi, one of three things tends to happen: 1. You get full-own Lyme disease and your immune system cannot clear the infection without antibiotics. You will also be more likely to get chronic Lyme disease, 2. You get Lyme disease and you clear the infection, and 3. Your immune system clears the bacteria very quickly before it has spread and you do not get sick. Some people are genetically more susceptible to getting Lyme disease based on how their white blood cells process the threat. Special genetic testing exists to evaluate the risk of susceptibility.
Not everyone develops a rash with acute Lyme disease. When present, the rash may be bullseye or “pancake” shape, appear like cellulitis or dermatitis, or not be present at all. Although not proven, in my experience, people tend to get a rash the first time they get Lyme disease but not on subsequent reinfections. Only about 50% of people recall a tick bite. Other symptoms include an expanding circular skin rash (erythema migrans) at the site of the tick bite, fever, generalized fatigue, headache, joint swelling (usually a knee), numbness and tingling, very slow heart rate, muscle pain, and joint pain. Most symptoms occur within 14 days of a tick bite, although some, such as joint symptoms, slow heart rate, and tingling and numbness, may start at least a month after a bite.
Since the early 1990s, the US Army has completed multiple Lyme Diseaese Risk Assements at Ft. Stewart, Ft. Benning, and the Marine Corp Logistics Base in Daugherty County GA. All of these assessments found black legged ticks and B. Burgdorferi in mammals at the facilities. Despite this, for many years the CDC continued to state that Lyme disease is not in Georgia. Today, the CDC states that the risk is low.
What is STARI?
After 10 years of research, the Medical College of Georgia was able to convince the scientific community that the lone star tick has the ability to transmit an infection causing “Lyme disease.” Southern Tick-Associated Rash Illness (STARI) is simply a southern Lyme-like illness transmitted by the lone star tick, and not the blacklegged tick. It is not completely clear what bacteria or infectious agent is transmitted by the tick; however, another strain of Borrelia, Borrelia lonestarii, has been found in approximately 50% of cases studied. If you know the symptoms of Lyme disease, you know the symptoms of STARI. Symptoms include an expanding circular skin rash (erythema migrans) at the site of the tick bite, fever, generalized fatigue, headache, muscle, and joint pain. Notice the symptoms are the same as Lyme disease. Often the rash is lighter and not as defined as a rash from Borrelia burgdorferi.
Unlike Lyme disease, there is no commercially available antibody or PCR tests to evaluate for the infectious agent. Prudent physicians will clinically diagnose the illness. There is also no clear treatment, although prudent physicians will treat STARI the same way they treat Lyme disease.
Alpha-gal Syndrome
Another concerning illness that the lone star tick causes in an allergy to red meats which unfortunately extends to all mammalian meat including pork. The allergic reaction may even extend to dairy products and gelatin.
When bitten by a lone star tick, the tick transfers a sugar, galactose-alpha-1,3-galactose (alpha-gal), into the tissues. As the innate immune cells show up and start to attack and clear the threat, some people have the bad luck of developing antibodies to the alpha-gal. The problem is that alpha-gal is found in all mammalian meat. When a person eats red meat, he or she may develop a clear and severe allergic reaction such as anaphylaxis or respiratory symptoms or have symptoms such as nasuea, vomiting, abdominal pain, cramping, diarrhea, and hives of unknown cause. Over 74% of those affected will have skin symptoms with recurrent hives being the most common. Abdominal symptoms occur in 30%. The reaction may occur soon after ingestion or be delayed by a day or more making it difficult to pinpoint a particular food as causing the symptom.
The good news is there is antibody test that can be done to evaluate for this condition. Avoidance of red meats relieves symptoms, although some must also avoid dairy and beef gelatin. Allergists have reported that the allergy may last 7-10 years after which, it may resolve.
Other Infections
Unfortunately, the lone star tick transmits bacteria, including Francisella tularensis, Rickettsia amblyommii, Ehrlichia chaffeensis, and Coxiella burnetti. Although rare, all of these bacteria cause serious and life-threatening illnesses.
Functional Medicine Approach
A primary care physician or urgent care best treats acute tick-borne illnesses. If symptoms of Lyme disease occur, do not wait to get treatment. A functional medicine approach by a prescribing clinician is most helpful in treating chronic tick-borne diseases (chronic Lyme disease) that result from innate immune system dysfunction triggered by persisting toxins produced by Borrelia species. Currently, there are multiple protocols for addressing chronic Lyme disease. There is no consensus by "big science/big medicine" about the best course of treatment.
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