An Observational Study of Sepsis in Takeo Province Cambodia: An in-depth examination of pathogens causing severe infections

PLoS Negl Trop Dis. 2020 Aug 17;14(8):e0008381. doi: 10.1371/journal.pntd.0008381. eCollection 2020 Aug.


The world's most consequential pathogens occur in regions with the fewest diagnostic resources, leaving the true burden of these diseases largely under-represented. During a prospective observational study of sepsis in Takeo Province Cambodia, we enrolled 200 patients over an 18-month period. By coupling traditional diagnostic methods such as culture, serology, and PCR to Next Generation Sequencing (NGS) and advanced statistical analyses, we successfully identified a pathogenic cause in 46.5% of our cohort. In all, we detected 25 infectious agents in 93 patients, including severe threat pathogens such as Burkholderia pseudomallei and viral pathogens such as Dengue virus. Approximately half of our cohort remained undiagnosed; however, an independent panel of clinical adjudicators determined that 81% of those patients had infectious causes of their hospitalization, further underscoring the difficulty of diagnosing severe infections in resource-limited settings. We garnered greater insight as to the clinical features of severe infection in Cambodia through analysis of a robust set of clinical data.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteria / classification
  • Bacterial Infections / diagnosis
  • Bacterial Infections / epidemiology
  • Cambodia / epidemiology
  • Female
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prospective Studies
  • Sepsis / epidemiology*
  • Sepsis / etiology*
  • Sepsis / microbiology*
  • Sepsis / virology
  • Sequence Analysis, RNA
  • Serologic Tests
  • Virus Diseases / diagnosis
  • Virus Diseases / epidemiology
  • Viruses / classification

Grant support

Funding for this work was provided by the Defense Threat Reduction Agency (DTRA, www.dtra.mi) awarded to JVL (CB3967). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.