{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:39:54Z","timestamp":1765827594876},"reference-count":20,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10,11]]},"abstract":"<jats:p>Coinfection with pathogens that cause acute febrile illness (AFI) can complicate patient diagnosis and management. This report describes a fatal case of <jats:italic>Leptospira<\/jats:italic> spp.\/Zika virus (ZIKV) coinfection in Puerto Rico. The patient presented with a 5-day history of AFI; reported behavioral risk factors for leptospirosis; was diagnosed with possible leptospirosis, dengue, chikungunya, or ZIKV disease; and received appropriate treatment for leptospirosis and dengue. Following a 3-day hospitalization, the patient died due to acute gastrointestinal hemorrhage, and kidney and liver failure. Serologic diagnostic testing for leptospirosis and ZIKV disease was negative; however, molecular diagnostic testing performed postmortem was positive for detection of <jats:italic>Leptospira<\/jats:italic> spp. and ZIKV nucleic acid. This case demonstrates the need for continued clinical awareness of leptospirosis in areas experiencing outbreaks of pathogens that cause AFI and the need for evaluation of coinfection with AFI-causing pathogens as a risk factor for increased severity of disease.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0250","type":"journal-article","created":{"date-parts":[[2017,7,3]],"date-time":"2017-07-03T07:01:27Z","timestamp":1499065287000},"page":"1085-1087","source":"Crossref","is-referenced-by-count":13,"title":["Fatal Leptospira spp.\/Zika Virus Coinfection\u2014Puerto Rico, 2016"],"prefix":"10.4269","volume":"97","author":[{"given":"Paige","family":"Neaterour","sequence":"first","affiliation":[{"name":"Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aidsa","family":"Rivera","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renee L.","family":"Galloway","sequence":"additional","affiliation":[{"name":"Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myriam Garcia","family":"Negr\u00f3n","sequence":"additional","affiliation":[{"name":"Puerto Rico Department of Health, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda","family":"Rivera-Garcia","sequence":"additional","affiliation":[{"name":"Puerto Rico Department of Health, San Juan, Puerto Rico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler M.","family":"Sharp","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Clin Infect Dis","first-page":"1834","article-title":"Assessment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974\u20131998","volume":"33","author":"Katz","year":"2001"},{"key":"b2","series-title":"Emerg Infect Dis","first-page":"91","article-title":"Outbreak of leptospirosis after flood, the Philippines, 2009","volume":"18","author":"Amilasan","year":"2012"},{"key":"b3","series-title":"Lancet Infect Dis","first-page":"757","article-title":"Leptospirosis: a zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003"},{"key":"b4","series-title":"Braz J Infect Dis","first-page":"10","article-title":"Clinical presentation of leptospirosis: a retrospective study of 201 patients in a metropolitan city of Brazil","author":"Daher","year":"2010"},{"key":"b5","series-title":"PLoS Negl Trop 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