Alastrim

ALASTRIM, alastrim (from the Portuguese alastrar — to burn, to scatter sparks), an acute smallpox-like exanthema occurring primarily in tropical countries and among colored races. The disease was first described in the 1860s in Central America, then in South America, the West Indies, Australia, and more recently in the United States of America and Western Europe (in Portugal, Switzerland, and England). The etiology and place of Alastrim in the nosological system have not been clarified, but it is apparently a disease sui generis, clinically of an intermediate type between smallpox (variola) and chickenpox (varicella). Alastrim begins with a sharp headache, pain in the arms and legs, irritation of the mucous membranes, malaise, and a rise in temperature (usually not exceeding 38–39°C). After 2–3 days, the temperature falls, and after 6–8 days, a nodular-vesicular rash appears on the patient, resembling transparent amber-colored beads. Suppurative fever during the transition of vesicles into pustules is absent. Healing occurs without scarring; confluent forms are very rare. The general condition of the patient almost always remains good. Complications are very rare. The total duration of the disease is about 14 days. Harta observed reinfection with Alastrim. According to immunological reactions, Alastrim is identical neither to smallpox nor to vaccine (cowpox). Having had smallpox does not protect against Alastrim. The vaccine protects against Alastrim, but those who have had Alastrim develop only short-term immunity to the vaccine. In contrast to smallpox, Alastrim is characterized by: 1) low mortality (0.1–1.0%, rarely 2–2.5%), 2) the mild nature of the disease among children, 3) the absence of scarring, 4) the absence of suppurative fever, 5) a short period of immunity to the vaccine in those who have had Alastrim. Although the relationship of smallpox to Alastrim has not been definitively clarified, there is, without a doubt, a close kinship between the two diseases. Carini and Aragao succeeded in inducing keratitis with Guarnieri bodies on the cornea of a rabbit using the contents of Alastrim pocks. Other authors report a positive result of Paul's test in Alastrim. Apparently, Alastrim represents an attenuated form of smallpox, and the same measures of control and prevention are appropriate for Alastrim as for smallpox (see), i.e., primarily mass anti-smallpox vaccinations. M. Morozov.