252 Organism Pathogens: Achromobacter xylosoxidans Actinomyces radingae Beta hemolytic streptococci group C Brevundimonas vesicularis Burkholderia cepacia Burkholderia pseudomallei Edwardsiella tarda Escherichia coli Group D Salmonella sp. non-typhi Gemella morbillorum Moraxella catarrhalis Moraxella sp. non-catarrhalis Neisseria sp. non-meningitidis Pasteurella sp. Pseudomonas aeruginosa Ralstonia pickettii Rhodococcus sp. Salmonella choleraesuis Salmonella Group D sp. non-typhi Salmonella ser. Paratyphi A Salmonella typhi Sphingomonas paucimobilis Staphylococcus aureus Stenotrophomonas maltophilia Streptococcus constellatus Streptococcus mitis Streptococcus pneumonia Aspergillus sp. Candida sp. other than albicans KASPER AND OTHERS TABLE 4 Organisms isolated from 9821 patient blood cultures TOTAL Organism 1 3 1 7 1 2 1 12 1 2 6 3 2 1 1 1 15 10 1 6 57 6 4 2 1 1 1 2 14 Potential pathogens: Acinetobacter baumannii/calcoaceticus Acinetobacter lwoffii Bacillus sp. Chryseobacterium indologenes Mannheimia haemolytica/P. trehalosi Ochrobactrum anthropi Pseudomonas fluorescens Pseudomonas oryzihabitans Pseudomonas putida Pseudomonas stutzeri Likely contaminants: Aerococcus viridans Arthrobacter sp. Brevibacterium sp. Cellulomonas sp. Cellulosimicrobium cellulans Coagulase negative Staphylococcus Corynebacterium sp. Leifsonia aquatica Microbacterium sp. Micrococcus sp. TOTAL 3 3 2 1 3 1 1 1 1 1 1 37 1 1 1 203 16 1 35 20 identified a number of unique co-infections such as Dengue and B. pseudomallei and S. typhi. The co-infections with malaria may represent asymptomatic infections among our study population. Currently, our group has several malaria- specific studies underway, accessing prevalence, incidence, and drug resistance. Our study identified over 50 co-infected cases of influenza and dengue, previous reports have also iden- tified cases and concurrent outbreaks.5,31,32 Further studies are required to better understand the clinical outcome of patients who have tested positive for multiple pathogens. The use of laboratory-based syndromic surveillance can alert regional officials and describe common infectious etiolo- gies circulating in the region during a specific time period. Furthermore, laboratory-based syndromic surveillance can be used to help define symptoms and information that can be used for electronic-based surveillance programs and help to guide outbreak response and laboratory testing. Testing for a number of pathogens in all samples as opposed to using a staged screening strategy allowed us to identify TABLE 5 List of unique or uncommon co-infections identified from polymerase chain reaction (PCR) positive Co-infection (n) n Notes Influenza/dengue Influenza/malaria Influenza/blood culture Dengue/malaria Dengue/blood culture Dengue/blood culture Dengue/blood culture Malaria/blood culture Influenza/dengue/blood culture 55 55 are PCR positive for dengue 8 10 15 15 are PCR positive for dengue 1 B. pseudomallei and dengue-2 2 S. typhi and dengue-4 1 S. typhi and dengue-2 1 1 S. cholerasuis and dengue-4 co-infections that may have otherwise been missed. The diver- sity of etiological agents, an inability to identify an etiology in the majority of enrolled patients, and the prevalence of multiple infections, demonstrate the complexity of diagnosis and treat- ment of medical care providers in this region of Cambodia. Received June 24, 2011. Accepted for publication October 14, 2011. Acknowledgments: We are grateful to the clinicians and medical staff at the field sites in Cambodia for their assistance in enrolling and sampling patients. We thank laboratory personnel and field staff of NAMRU2-Phnom Penh for the conduct of work performed in sup- port of this study. Financial support: This work was funded by the U.S. Department of Defense Global Emerging Infectious Systems (DoD-GEIS), the Biosecurity Engagement Program, U.S. Department of State, and the U.S. Centers for Disease Control and Prevention. Disclaimer: The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Disclosure: This work was prepared as part of the authors’ official duties. Title 17 U.S.C. }105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. }101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Authors’ addresses: Matthew R. Kasper, Department of Bacteriology, U.S. Naval Medical Research Unit 6, Lima, Peru, E-mail: matthew .kasper@med.navy.mil. Patrick Blair, Naval Health Research Center, San Diego, CA, E-mail: Patrick.blair@med.navy.mil. Sok Touch, Com- municable Disease Control Department, Phnom Penh, Kingdom of Cambodia, E-mail: touch358@moh.gov.kh. Buth Sokhal, National Institute of Public Health, Phnom Penh, Kingdom of Cambodia, E-mail: buthsokhal@yahoo.com. Chadwick Yasuda, U.S. Naval Medical Research Unit Two, Phnom Penh, Kingdom of Cambodia,