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Also, EM rashes have been reported in association with organisms other than members of\n                    <jats:italic toggle=\"yes\">Borrelia burgdorferi<\/jats:italic>\n                    sensu lato complex. Arthropod saliva has chemicals that have effects on the host and pathogen transmission. Tick saliva has protein families similar to spiders and scorpions and even substances homologous to those found in snakes and other venomous animals. Ticks \u201cinvertebrate pharmacologists\u201d have a sophisticated arsenal of chemicals that assist in blood feeding, pathogen transmission, and suppressing host defenses. No organisms have been isolated from many EM rashes. We propose that tick salivary toxins may play a role in the causation of rashes and laboratory abnormalities in tick-borne diseases. The role of tick salivary toxins needs further exploration.\n                  <\/jats:p>\n                  <jats:p>\n                    Cases of Lyme-like EM rashes referred to as STARI (Southern Tick-Associated Rash Illness) following bites of the lone star tick,\n                    <jats:italic toggle=\"yes\">Amblyomma americanum<\/jats:italic>\n                    , in the United States have been reported predominantly in Southeastern Missouri and a few in South Carolina, North Carolina, Georgia, and one case each in Mississippi and Long Island, New York. Although there is one report of\n                    <jats:italic toggle=\"yes\">Borrelia lonestari<\/jats:italic>\n                    in a patient with a rash, biopsies of 31 cases of STARI, with cultures and PCR, failed to show a relationship. Distribution of\n                    <jats:italic toggle=\"yes\">A. americanum,<\/jats:italic>\n                    whose bites are associated with STARI, now extends along the East Coast of the United States, including New Jersey, up to the Canadian border. As far as we are aware, there have been no prior reports of Lyme-like rashes in New Jersey. In this study, we present case examples of 2 Lyme-like rashes, variations of EM rashes, and a brief review of studies that suggest a role of tick salivary toxins in tick-borne diseases.\n                  <\/jats:p>","DOI":"10.1089\/vbz.2018.2278","type":"journal-article","created":{"date-parts":[[2018,8,21]],"date-time":"2018-08-21T11:44:17Z","timestamp":1534851857000},"page":"641-652","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Report of Non-Lyme, Erythema Migrans Rashes from New Jersey with a Review of Possible Role of Tick Salivary Toxins"],"prefix":"10.1177","volume":"18","author":[{"given":"Don Walter","family":"Kannangara","sequence":"first","affiliation":[{"name":"St Luke's Health NetWork"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pritiben","family":"Patel","sequence":"additional","affiliation":[{"name":"St Luke's Health NetWork"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12941-017-0179-z"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid1612.100417"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/650172"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2012.12-0153"},{"key":"e_1_3_3_6_1","volume-title":"Annual Meeting of the American Society of Tropical Medicine","author":"Aucott JN","year":"2017","unstructured":"Aucott JN, , Rebman AW, , Schutzer SE et al. 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