Sir.—I read with interest the letter by Roscelli1 concerning hemorrhagic shock and encephalopathy (HSE) syndrome.
Roscelli stated that "The shock state is very impressive in that it requires almost unbelievable amounts of volume expanders to reverse it, and occurs suddenly without any loss of extracellular fluid or blood from the body." The conditions mentioned in this description of HSE syndrome are exactly the same as those we have encountered in dengue shock syndrome. I believe hematocrit levels increase significantly in HSE, probably because of plasma leakage into extravascular space.
In Indonesia, conditions similar to HSE have usually been evaluated after determining serum titers for the dengue virus. A vector such as the Aedes species is needed to spread the dengue virus in the United States. However, during the last 10 years the dengue virus has also spread through the Caribbean basin and surrounding areas. Several cases have progressed