ABSTRACT Introduction: The most common form of severe dengue is the dengue shock syndrome. However, infants with dengue don´t present the clinical manifestations that characterize it neither have this complication as often as older patients do. Objective: To know the clinical and laboratory characteristics of a patient of less than one-year-old whose dengue shock syndrome was initially interpreted as a case of severe sepsis. Case presentation: 8-months-old female patient with fever and diarrhea that was checked in more than one hospital and the mother refuses to hospitalize her. In the fifth day of being ill appeared exanthem, and having fever she presented cyanosis and other signs of tisular hypoperfusion, being initially diagnosed a sepsis shock. She responded satisfactorily to the replacement of crystalloid fluids intravenously administered initially and she was sent to a pediatric intensive care unit where she continued receiving rehydration treatment and antibiotic therapy was started. Subsequently, sepsis was ruled out due to the case´s evolutions and the clinical and microbiological laboratory´s results, as well as a serology positive to dengue fever. Conclusions: Dengue shock syndrome in an infant can present without its typical clinical manifestations and for its diagnosis is essential to consider the epidemiological history.

RESUMEN Introducción: La forma más frecuente de dengue grave es el choque por dengue. Sin embargo, los lactantes con dengue no presentan las manifestaciones clinicas que lo caracterizan ni tienen tan a menudo esta complicación como lo hacen los pacientes con edades mayores. Objetivo: Dar a conocer las características clinicas y laboratoriales de una paciente menor de un año de edad cuyo síndrome de choque por dengue fue interpretado inicialmente como un caso de sepsis grave. Presentación del caso: Paciente femenina de 8 meses de edad con fiebre y diarreas que concurre a más de un centro hospitalario y la madre se niega a ingresarla. Al quinto dia de enfermedad apareció exantema y ya estando afebril presenta cianosis y otros signos de hipoperfusión tissular, haciéndole diagnóstico inicial de choque por sepsis. Responde satisfactoriamente a la reposición de líquidos cristaloides por via intravenosa administrados inicialmente y es enviada despues a una unidad de terapia intensiva pediátrica donde continua recibiendo tratamiento de rehidratacion y se inicia antibioticoterapia. Posteriormente, la sepsis fue descartada por la evolución del caso y los resultados de laboratorio clinico y microbiológicos, asi como una serología positiva a dengue. Conclusiones. El choque por dengue en el lactante puede expresarse sin su cuadro clinico típico y para su diagnostico es imprescindible considerar el antecedente epidemiológico.

ABSTRACT Dengue and COVID-19 are two diseases that threaten many populations in the region of the Americas and which co-exist in Cuba. They both have similarities and differences which force doctors in charge to do a differential diagnosis among both diseases because each can be a cause of death. The objective of this work is contributing to the correct diagnosis of each patient and their better care. There was a review of the current concepts on etiology and pathogenesis of both diseases, as well as their clinical profile, care and prevention. Dengue as COVID-19 has a fever period and a critical one, both are systemic infections and their initial symptoms can be similar and might not be the same of the subsequent typical clinical picture, particularly in pediatric ages. Dengue defines its evolution in one week and the disease caused by the new coronavirus needs at least three weeks for its recovery or fatal evolution. Each similarity and difference among each disease was analyzed taking into account the most updated national and international criteria higlighting the best way to treat each patient avoiding complications and deads.

RESUMEN Dengue y COVID-19 son dos enfermedades que amenazan a poblaciones enteras en la Región de Las Américas y coexisten en Cuba. Tienen semejanzas y diferencias que obligan a los médicos tratantes a hacer el diagnóstico diferencial entre ambas pues cada una puede ser causa de muerte. El objetivo del presente trabajo es contribuir al diagnóstico correcto de cada enfermo y su mejor atención. Se revisaron los conceptos actuales sobre etiología y patogenia de ambas, así como su cuadro clínico, cuidado y prevención. Tanto dengue como COVID-19 tienen un periodo febril y otro crítico, ambas son infecciones sistémicas y sus síntomas iniciales pueden ser parecidos entre sí y no ser los mismos del cuadro típico o característico posterior, particularmente en la edad pediátrica. El dengue define su curso en una semana y la enfermedad por el nuevo coronavirus tiene al menos tres semanas para su restablecimiento o evolución fatal. Cada semejanza y diferencia entre ambas fue objeto de análisis considerando los criterios nacionales e internacionales más actualizados haciendo énfasis en la mejor manera de tratar cada paciente para evitar complicaciones y muerte.

Foi realizada uma revisão completa da Dengue Hemorrágica, doença infecciosa viral aguda e potencialmente, grave, transmitida por mosquito, que, em 1981, causou a morte de 158 pessoas durante uma epidemia em Cuba, sendo 101 menores de 15 anos. A Dengue, em sua forma clássica (benigna), foi primeiramente referida em 1823, porém,no ano de 1953, em Manila, Filipinas, se registrou uma nova apresentação da doença, caracterizada por manifestações hemorrágicas, choque e alta mortalidade que se denominou Febre Hemorrágica Dengue e Síndrome de Choque por Dengue (FHD/SSD). Sua patogenia é apresentada, discutindo-se também a possibilidade de repetição do fenômeno nas Américas.

A thorough revision on hemorragic dengue fever is presented. Dengue, an acute mosquito-borne infectious disease has occurred in epidemic form in Cuba 1981, causing death of 158 persons. The disease in its classical form was first reported in 1823 but in 1953 a new presentation characterized by hemorrhagic manifestations, shock and a high mortality was observed in Manila, Phillipines. This form was called Hemorrhagic Dengue Fever and Dengue Shock Syndrome (HDF/DSS). Its pathogenesis can be explained by two different theories: it could be a primary infection or a hipersensibility reaction depending on a previous infection.

Foi realizada uma revisão completa da Dengue Hemorrágica, doença infecciosa viral aguda e potencialmente, grave, transmitida por mosquito, que, em 1981, causou a morte de 158 pessoas durante uma epidemia em Cuba, sendo 101 menores de 15 anos. A Dengue, em sua forma clássica (benigna), foi primeiramente referida em 1823, porém,no ano de 1953, em Manila, Filipinas, se registrou uma nova apresentação da doença, caracterizada por manifestações hemorrágicas, choque e alta mortalidade que se denominou Febre Hemorrágica Dengue e Síndrome de Choque por Dengue (FHD/SSD). Sua patogenia é apresentada, discutindo-se também a possibilidade de repetição do fenômeno nas Américas.

A thorough revision on hemorragic dengue fever is presented. Dengue, an acute mosquito-borne infectious disease has occurred in epidemic form in Cuba 1981, causing death of 158 persons. The disease in its classical form was first reported in 1823 but in 1953 a new presentation characterized by hemorrhagic manifestations, shock and a high mortality was observed in Manila, Phillipines. This form was called Hemorrhagic Dengue Fever and Dengue Shock Syndrome (HDF/DSS). Its pathogenesis can be explained by two different theories: it could be a primary infection or a hipersensibility reaction depending on a previous infection.

Uma epidemia de Dengue hemorrágica ocorreu em Cuba no ano de 1981. Entre a população de cerca de 10 milhões de habitantes, registraram-se 344.203 casos, sendo 71,3% em adultos e o restante crianças, entre as quais a doença se apresentou com maior gravidade. Durante o pico da epidemia, foram notificados 11.271 casos em um único dia. Neste trabalho se expõem os aspectos organizativos do atendimento médico durante a epidemia e o estudo realizado em 2239 pacientes hospitalizados com diagnóstico confirmado de Dengue hemorrágica, em três hospitais da Cidade de Havana, no período junho - agosto de 1981. Apresentam-se as principais manifestações clínicas e humorais de uma amostra de 2239 pacientes menores de 15 anos de idade. Discute-se ainda alguns aspectos terapêuticos, inclusive a experiência do autor com o uso de interferon em 166 pacientes.

An outbreak of hemorrhagic dengue fever occurred in Cuba in 1981. Among a population of about 10 million people, 344.203 persons were affected; 71,3% of these were adults and the remaining were children. Among the latter the disease was more severe. During the peak of the epidemic up to 11. 701 cases were reported in one single day. In this article the organizational aspects of health care delivery durint the epidemics as well as the studies performed in the 2239 patients admited to 3 hospitals of the city of La Habana from June to August 1981 are reported. The most important clinical and laboratory data from sample of 2239 patients under 15 years of age are presented. Some therapeutic aspects, including the experience of the author with the use of in tereferon in 166 patients, are also discussed.

Uma epidemia de Dengue hemorrágica ocorreu em Cuba no ano de 1981. Entre a população de cerca de 10 milhões de habitantes, registraram-se 344.203 casos, sendo 71,3% em adultos e o restante crianças, entre as quais a doença se apresentou com maior gravidade. Durante o pico da epidemia, foram notificados 11.271 casos em um único dia. Neste trabalho se expõem os aspectos organizativos do atendimento médico durante a epidemia e o estudo realizado em 2239 pacientes hospitalizados com diagnóstico confirmado de Dengue hemorrágica, em três hospitais da Cidade de Havana, no período junho - agosto de 1981. Apresentam-se as principais manifestações clínicas e humorais de uma amostra de 2239 pacientes menores de 15 anos de idade. Discute-se ainda alguns aspectos terapêuticos, inclusive a experiência do autor com o uso de interferon em 166 pacientes.

An outbreak of hemorrhagic dengue fever occurred in Cuba in 1981. Among a population of about 10 million people, 344.203 persons were affected; 71,3% of these were adults and the remaining were children. Among the latter the disease was more severe. During the peak of the epidemic up to 11. 701 cases were reported in one single day. In this article the organizational aspects of health care delivery durint the epidemics as well as the studies performed in the 2239 patients admited to 3 hospitals of the city of La Habana from June to August 1981 are reported. The most important clinical and laboratory data from sample of 2239 patients under 15 years of age are presented. Some therapeutic aspects, including the experience of the author with the use of in tereferon in 166 patients, are also discussed.