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Lyme Disease vs. STARI: Tell Them Apart!

Differentiating Early Lyme Disease and Southern Tick-Associated Rash Illness

At a Glance

Researchers at Colorado State University have developed a new blood-based method to distinguish early Lyme disease from Southern Tick-Associated Rash Illness (STARI). The approach analyzes small molecules in patient blood to detect unique disease signatures. It achieves up to 98% accuracy when classifying these conditions. This method provides a more reliable way to support early diagnosis and treatment decisions.

Background

Lyme disease is the most commonly reported vector-borne illness in the United States and requires early diagnosis for effective treatment. Its hallmark rash can resemble that of STARI, a similar illness with no confirmed cause or standard diagnostic test. Because both conditions occur in overlapping regions, misdiagnosis is common. A reliable way to distinguish between them is critical for improving patient outcomes and guiding appropriate care. 

Overview

This technology uses an unbiased metabolomics approach to analyze blood samples from patients and identify disease-specific metabolic profiles. By comparing patterns of small molecules present in the blood, the method detects consistent differences between early Lyme disease and STARI. These metabolic signatures are then used to train classification models that can assign new patient samples to the correct condition. 

When tested on independent sample sets, the models achieved classification accuracy ranging from 85% to 98%, with particularly strong performance indicated by an area under the curve (AUC) of 0.986. This high level of accuracy demonstrates the method’s ability to reliably separate two clinically similar conditions that are otherwise difficult to distinguish using current diagnostic approaches. 

Figure 1. Evaluation of classification models’ performance. (A) Scores for early Lyme disease (green dots) and STARI (blue triangles) samples were calculated using this specific method. These scores show how likely it is that a sample belongs to each group. (B) An ROC curve shows how well the method can tell early Lyme disease and STARI apart. The curve indicates high accuracy, with an AUC of 0.986. (C) Scores for early Lyme disease, STARI, and healthy control samples were calculated. These scores help predict which group a sample belongs to.
Figure 1. Model performance results. (A) The method assigns scores to each sample, showing how likely it is to be early Lyme disease (green dots) or STARI (blue triangles). (B) The ROC curve shows how well the method separates the two conditions, with very high accuracy (AUC = 0.986). (C) Scores are also shown for early Lyme disease, STARI, and healthy samples, helping predict which group each sample belongs to.

Benefits

  • Accurately differentiates early Lyme disease from STARI using a simple blood sample  
  • Achieves high diagnostic performance, with up to 98% accuracy 
  • Supports earlier and more appropriate treatment decisions
  • Reduces the risk of misdiagnosis in regions where both conditions are present
  • Lowers healthcare costs associated with delayed or incorrect treatment

Applications

  • Hospitals, clinics, and primary care settings for improved diagnostic support 
  • Diagnostic laboratories developing advanced blood-based tests 
  • Public health programs focused on tick-borne disease management 
  • Research organizations studying Lyme disease and related conditions 

Publications

C. Molins, et al (2017) “Metabolic differentiation of early Lyme disease from southern tick–associated rash illness (STARI).” Science Translational Medicine. https://doi.org/10.1126/scitranslmed.aal2717

Last Updated: June 2026
Close-up of a reddish-brown tick on a green blade of grass with a blurred green background.
Opportunity

Available for Exclusive Licensing
TRL: 4

IP Status

US 11,230,728 
 

Inventors

John Belisle
Claudia Molins
Gary Wormser

Reference Number
17-086
Licensing Manager

Jessy McGowan
Jessy.McGowan@colostate.edu
970-491-7100

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