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Background  Recently, metagenomic studies have identified viable  Pepper mild mottle virus  (PMMoV), a plant virus, in the stool of healthy subjects. However, its source and role as pathogen have not been determined.    Methods and Findings  21 commercialized food products containing peppers, 357 stool samples from 304 adults and 208 stool samples from 137 children were tested for PMMoV using real-time PCR, sequencing, and electron microscopy. Anti-PMMoV IgM antibody testing was concurrently performed. A case-control study tested the association of biological and clinical symptoms with the presence of PMMoV in the stool. Twelve (57%) food products were positive for PMMoV RNA sequencing. Stool samples from twenty-two (7.2%) adults and one child (0.7%) were positive for PMMoV by real-time PCR. Positive cases were significantly more likely to have been sampled in Dermatology Units ( p <10 −6 ), to be seropositive for anti-PMMoV IgM antibodies ( p  = 0.026) and to be patients who exhibited fever, abdominal pains, and pruritus ( p  = 0.045, 0.038 and 0.046, respectively).    Conclusions  Our study identified a local source of PMMoV and linked the presence of PMMoV RNA in stool with a specific immune response and clinical symptoms. Although clinical symptoms may be imputable to another cofactor, including spicy food, our data suggest the possibility of a direct or indirect pathogenic role of plant viruses in humans.

Pepper Mild Mottle Virus, a Plant Virus Associated with Specific Immune Responses, Fever, Abdominal Pains, and Pruritus in Humans