Southern tick-associated rash illness (STARI) is an emerging infectious disease related to Lyme disease that occurs in southeastern and south-central United States. It is spread by tick bites and it was hypothesized that the illness was caused by the bacteria Borrelia lonestari. However, there is insufficient evidence to declare this Borrelia strain as a causative agent. Symptoms
Diagnosis is based on a circular "bulls-eye" rash at the site of infection called erythema chronicum migrans, which is very similar to that seen in Lyme disease. However, the symptoms of STARI are mild,  and resemble influenza, with fatigue, muscle pains, and headache. Fever is sometimes seen, but is not characteristic. Causes
This illness is a tick-borne disease carried by the lone star tick Amblyomma americanum. This tick was first proposed as a possible vector of disease in 1984, and the illnesses associated with the tick called "Lyme-like disease", but it was not  recognized to be distinct from Lyme disease until the late 1990s.Several studies have failed to detect Borrelia burgdorferi, which is the causative agent of Lyme disease, in patients from the southern United States. This disease may be caused by the related bacterium Borrelia lonestari, which is a spirochete first isolated in culture in 2004. However, this conclusion is controversial since the spirochete is not detected in all cases of the syndrome, which has led some authors to argue that the illness is not caused by a bacterial pathogen. Treatment
Infections are treated with antibiotics, particularly doxycycline, and the acute symptoms appear to respond to these drugs.
Management
Apart from controlling other risk factors, the goal of therapy is to slow down or halt the progression of CKD. Control of blood pressure and treatment of the original disease are the broad principles of management. Blood pressure
Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are recommended as first-line agents since they have been found to slow the decline of kidney function, relative to a more rapid decline in those not on one of these agents. They have also been found to reduce the risk of major cardiovascular events such as myocardial infarction, stroke, heart failure, and death from cardiovascular disease when compared to placebo in individuals with CKD. ACEIs may be superior to ARBs for protection against progression to kidney failure and death from any cause in those with CKD. Aggressive blood pressure lowering decreases peoples risk of death. Other measures
Aggressive treatment of high blood lipids is recommended. A low-protein, low-salt diet may result in slower progression of CKD and reduction in proteinuria as well as controlling symptoms of advanced CKD to delay dialysis start. A tailored low-protein diet, designed for low acidity, may help prevent damage to kidneys for people with CKD. Additionally, controlling salt ingestion helps to decrease the incidence of coronary heart disease, lowering blood pressure and reducing albuminuria. Anemia - A target hemoglobin level of 9–12 g/dL is recommended; raising hemoglobin levels to the normal range has not been found to be of benefit.Guidelines recommend treatment with parenteral iron prior to treatment with erythropoietin.