title: Association of torovirus with acute and persistent diarrhea in children.
abstract: OBJECTIVE
  To study the etiologic role of toroviruses as a cause of gastroenteritis in humans.
  
  
  METHODS
  The design was a case-control study. We compared the rate of torovirus detection in fecal specimens from a selection of children with acute or persistent diarrhea and controls without diarrhea from a study of childhood diarrhea in an urban Brazilian slum. Stool samples were coded and tested in a blinded fashion for the presence of torovirus antigen by enzyme-linked immunosorbent assay, other enteropathogens, toxins and fecal leukocytes.
  
  
  RESULTS
  Thirty-three children with acute diarrhea, 41 children with persistent diarrhea and 17 controls were enlisted in the study. Torovirus antigen was detected in 9 (27%) samples from children with acute diarrhea, 11 (27%) samples from children with persistent diarrhea and none of the samples from controls (P < 0.05). In addition the presence of enteroaggregative E. coli was associated with persistent diarrhea and the presence of Cryptosporidium oocysts was common although not significant (P = 0.08); torovirus and Cryptosporidium occurred in different subsets of samples, whereas torovirus and enteroaggregative Escherichia coli were commonly found in combination.
  
  
  CONCLUSIONS
  These data indicate that toroviruses, alone or in combination with enteroaggregative E. coli, may play a pathogenic role in acute and possibly persistent diarrhea. Further studies are warranted to determine the etiologic role of toroviruses in gastroenteritis.
authors.affiliation: Research Laboratory for Infectious Diseases, National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands. marion.koopmans@rivm.nl
authors.forename: M P
authors.initials: MP
authors.lastname: Koopmans
authors.forename: E S
authors.initials: ES
authors.lastname: Goosen
authors.forename: A A
authors.initials: AA
authors.lastname: Lima
authors.forename: I T
authors.initials: IT
authors.lastname: McAuliffe
authors.forename: J P
authors.initials: JP
authors.lastname: Nataro
authors.forename: L J
authors.initials: LJ
authors.lastname: Barrett
authors.forename: R I
authors.initials: RI
authors.lastname: Glass
authors.forename: R L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D000208:Acute Disease; D000818:Animals; D000956:Antigens, Viral / Q000032:analysis*; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D002908:Chronic Disease; D003458:Cryptosporidium / Q000302:isolation & purification; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D004797:Enzyme-Linked Immunosorbent Assay; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology / Q000821:virology*; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D017003:Torovirus / Q000276:immunology*; D018176:Torovirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D014505:Urban Population
chemical_list: D000956:Antigens, Viral