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[Correspondence] Uncommon presentation of Zika fever or co-infection?

We read with great interest Ouafae Karimi and colleagues’ Correspondence (March 5, p 940)1 on severe thrombocytopenia and subcutaneous bleeding in a patient with Zika virus infection. High fever, haematomas, and severe thrombocytopenia are very uncommon in Zika virus infections. Fever over 39°C has been reported in seven Indonesian patients in 1977–78, in one Chilean traveller returning from Colombia in 2015, and in a Colombian and two Brazilian patients in 2015.2 Blood count abnormalities have been reported only sporadically in Zika fever and include mild thrombocytopenia (100 × 109 to 150 × 109 platelets per L), mild leucopenia (1·0 × 109 to 1·5 × 109 leucocytes per L), and the presence of activated lymphocytes.

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