title: Zika virus infection as an unexpected finding in a Leptospirosis patient.
abstract: BACKGROUND
  Areas where leptospirosis and arboviruses are endemic largely overlap in the tropics. However, the number of arbovirus infections is usually much higher. The initial clinical presentation can be highly confusing; therefore, laboratory confirmation is key to an accurate diagnosis.
  
  
  METHODS
  A 19-year-old man presented to a peripheral health centre with an acute febrile illness. Dengue was initially suspected, but the patient deteriorated to a shock syndrome. Leptospirosis as well as a co-infection with Zika virus were both confirmed in the laboratory, the latter being clinically masked in this dual infection.
  
  
  CONCLUSIONS
  This case highlights the importance of not only considering the differential diagnosis of acute febrile syndromes, but also to consider the possibility of dual infections in the context of global spread of arboviruses. The specific context of travellers returning from endemic areas and pregnant women is also highlighted and discussed.
authors.affiliation: Institut Pasteur de Nouvelle-Caledonie, Medical Virology Laboratory , Nouméa , New Caledonia.
authors.forename: Antoine
authors.initials: A
authors.lastname: Biron
authors.affiliation: Centre Hospitalier Territorial de Nouvelle-Caledonie, Infectious Disease Department , Nouméa , New Caledonia.
authors.forename: Cécile
authors.initials: C
authors.lastname: Cazorla
authors.affiliation: Centre Hospitalier Territorial de Nouvelle-Caledonie, Intensive Care Unit , Nouméa , New Caledonia.
authors.forename: Julien
authors.initials: J
authors.lastname: Amar
authors.affiliation: Gouvernement de la Nouvelle-Caledonie, Direction des Affaires Sanitaires et Sociales , Nouméa , New Caledonia.
authors.forename: Anne
authors.initials: A
authors.lastname: Pfannstiel
authors.affiliation: Institut Pasteur de Nouvelle-Caledonie, Arbovirus Research and Expertise Unit , Nouméa , New Caledonia.
authors.forename: Myrielle
authors.initials: M
authors.lastname: Dupont-Rouzeyrol
authors.affiliation: Institut Pasteur de Nouvelle-Caledonie, Leptospirosis Research and Expertise Unit , Nouméa , New Caledonia.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Goarant
keywords: amoxycillin; differential diagnosis; dual infection; leptospirosis; shock syndrome; zika virus