Practice-Based Research Network Partnership with CDC to Acquire Clinical Specimens to Study the Etiology of Southern Tick-Associated Rash Illness (STARI)

摘要

id="p1">Introduction: Erythema migrans (EM) is an annular, erythematous, expanding rash that is characteristic of early Lyme disease. In the southern United States, however, many cases of EM seem to have an etiology different from that of Lyme disease. This little-understood condition is called Southern tick-associated rash illness. id="p-2">Methods: With the goal of obtaining biological specimens and clinical histories from 12 to 20 STARI patients for use in etiologic research, microbiologists from the Centers for Disease Control and Prevention contacted the North Carolina Network Consortium, a statewide consortium of practice-based research networks. This article describes the methods by which the North Carolina Network Consortium successfully identified and enrolled Southern tick-associated rash illness patients into a primary care-based research protocol. id="p-3">Results: A total of 23 patients were enrolled, with 100% attainment of the desired specimens. After an initial lack of success, the revised protocol identified and trained physicians practicing in endemic areas for the illness, used a coordinator with 24-hour availability, recruited participants using newspaper notices and medical providers, and provided regular reminders and progress updates. id="p-4">Conclusions: A practice-based research network can help basic scientists identify patients and collect specimens for clinically relevant research. class="kwd-group KWD">

>class="kwd-search" href="/search?fulltext=Practice-Based+Research+Networks&sortspec=date&submit=Submit&andorexactfulltext=phrase">Practice-Based Research Networks

>class="kwd-search" href="/search?fulltext=PBRNs&sortspec=date&submit=Submit&andorexactfulltext=phrase">PBRNs

>class="kwd-search" href="/search?fulltext=Centers+for+Disease+Control+and+Prevention&sortspec=date&submit=Submit&andorexactfulltext=phrase">Centers for Disease Control and Prevention

>class="kwd-search" href="/search?fulltext=CDC&sortspec=date&submit=Submit&andorexactfulltext=phrase">CDC

>class="kwd-search" href="/search?fulltext=Southern+Tick-Associated+Rash&sortspec=date&submit=Submit&andorexactfulltext=phrase">Southern Tick-Associated Rash id="p-5">Erythema migrans (EM) is an annular, erythematous, expanding rash that is characteristic of early Lyme disease, an infectious disease that is endemic in the northeast, north central, and Pacific northwest of the United States. In the southeastern and southcentral states, cases of EM have also been reported since the mid 1980sid="xref-ref-1-1" class="xref-bibr" href="#ref-1">1–id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3; however, antibodies to Borrelia burgdorferi, the cause of Lyme disease, are infrequently identified in these patients and no cultures of B. burgdorferi have been grown from them.id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1,id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2,id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 Thus, EM in this region is believed to often represent an illness that is not Lyme disease, the etiology of which is unknown. This illness has been provisionally named Southern tick-associated rash illness (STARI). id="p-6">Compared with Lyme disease, which is transmitted by the tick vector Ixodes scapularis, STARI is associated with the bite from the lone star tick (Amblyomma americanum).id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5–id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7 In recent years, A. americanum has been increasingly reported in areas endemic for Lyme disease.id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6,id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8 Because a clinical diagnosis of early Lyme disease is often based on the presence of an EM rash, the increasing area of overlap where both tick vectors are present creates difficulties for diagnosis and treatment of patients with EM in these regions. id="p-7">Other than the known tick association, the etiology, natural history, and appropriate treatment of STARI remain largely unknown. Wormser et alid="xref-ref-9-1" class="xref-bibr" href="#ref-9">9,id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10 compared microbiologic and clinical characteristics of patients who had EM rashes in New York (an area endemic for Lyme disease) and Missouri (a nonendemic area). Although 75% of patients from New York were seropositive for antibodies to B. burgdorferi, all patents with EM from Missouri we