Browsing by Author "Hirsch, Tamara"

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    Does a clinical prediction rule anticipate the diagnosis for streptococcal pharyngitis in children aged 2 to 15?
    (SOC CHILENA INFECTOLOGIA, 2018) Katzulovic, Lorena; Garcia, Patricia; Wozniak, Aniela; Villarroel, Luis; Hirsch, Tamara; Concha, Ida; Catalan, Silvia; Cifuentes, Lorena
    Background: The etiology of a streptococcal pharyngitis must be documented by laboratory techniques to avoid unnecessary antimicrobial treatment, but this strategy increases cost for the patient. Available scores applied in children or adults are imperfect. Aim: To develop a clinical prediction rule to aid the diagnostic process of streptococcal pharyngitis (SP) in children in a low-resource setting. Methods: Three hundred and eighteen patients aged 2 to 15 years who were evaluated for suspected SP at the Pediatric Emergency Department and the Pediatric Ambulatory Unit of Red Salud UC-Christus entered the study. A throat culture and a rapid antigen detection test for Streptococcus pyogenes were obtained from each patient. Data were analyzed for possible clinical predictors of SP with univariate and multiple regression analyses. Results: Seventy-three cases of SP were diagnosed (23.9%). In the univariate analysis, fever was inversely associated with SP (p = 0.002). Odynophagia, palatal petechiae, and season of the year (autumn and winter) were positively associated with SP (p = 0.007, p < 0.001 and p = 0.03 respectively). In multiple regression analysis the models did not have sufficient power to predict streptococcal etiology. Conclusion: Clinical predictors, even those systematically included in clinical prediction rules, did not show sufficient predictive power to safely include or exclude SP in this setting, and thus, it is necessary to improve access to confirmatory tests.
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    Effectiveness of varicella vaccine as post exposure prophylaxis in Chilean children
    (SOC CHILENA INFECTOLOGIA, 2012) Pinochet, Constanza; Cerda, Jaime; Hirsch, Tamara; Mieres, Jocelyn; Inostroza, Carolina; Abarca, Katia
    Effectiveness of varicella vaccine as post exposure prophylaxis in Chilean children Introduction: Efficacy and effectiveness of varicella vaccine (VV) as post exposure prophylaxis (PEP) strategy have shown discordant results for disease risk reduction, and more consistent results in their ability to attenuate the disease. Aim: To assess the effectiveness of VV as PEP among household contacts. Material and Methods: We followed up 33 children after household exposure to a varicella case, of which 15 received VV as PEP and 18 did not received VV. The presence and severity of the disease were clinically determined. Results: Secondary attack rate was 53% among vaccinated and 89% among non-vaccinated children. Overall effectiveness of VV as PEP was 40% (CI95% 1%-64%). The effectiveness for preventing moderate or severe disease was 63% (CI95% 8%-85%) in the entire group and 77% (CI95% 14%-94%) among children vaccinated during the first 3 days post exposure. Vaccine tolerance was acceptable, with a low number of adverse reactions, all of them mild. Conclusion: The results suggest that VV as PEP is effective among household contacts, especially for reducing the severity of the disease.