In some of Gregory Storch's favorite childhood books, doctors don detective guises and track down mysterious maladies and killers. The tales, by journalist Berton Roueché, chronicle medical detective work on unusual cases by the Centers for Disease Control and Prevention (CDC).
Today, Storch, M.D., a professor of pediatrics and an infectious diseases expert, is himself a medical super sleuth. He helps develop molecular techniques to improve the diagnosis of infectious diseases, especially those that are difficult to uncover.
His laboratory has been at the forefront of using a technique called polymerase chain reaction (PCR) to detect telltale signs of infectious diseases. Unlike the commonly used culture methods, PCR can detect DNA and RNA in numerous bodily fluids, uncovering evidence of HIV in infants, cytomegalovirus, herpes simplex encephalitis, viral meningitis, and numerous other diseases.
"We're in a period of very rapid discovery in which the causes of a number of previously unknown diseases are being discovered through molecular methods," said Storch, who also is an associate professor of medicine and of molecular microbiology and is director of the Clinical Microbiology Laboratories at St. Louis Children's Hospital.
The last 20 years in infectious diseases, he said, have been similar to a period in the 1880s when Robert Koch, one of the fathers of modern microbiology, first learned how to culture bacteria.
"All of a sudden, he developed new methods, and that led to an explosion of information about certain disease-causing bacteria," Storch said.
"Most families in our neighborhood had parents who were first- or second-generation Americans. Thinking back, I think that probably influenced things," he said. "People were still feeling their way in the United States."
Storch's parents were the children of immigrants -- from Austria, Russia and Lithuania.
Storch, like many during the late 1950s, was affected by Sputnik. He always had been interested in science, and he took full advantage of the bounty of science programs in public schools that resulted from Sputnik. During high school, he participated in two laboratory summer programs sponsored by the National Science Foundation.
At Harvard University, where he began pursuing an undergraduate degree in 1965, Storch started out majoring in biochemistry but changed to a program called "History and Science." As a result, he often thinks about the history of biology and microbiology.
"There are certain common themes you can trace through the last several hundred years of science. Some of the studying I did then helps me be aware of that," he said.
In college, Storch knew he probably would be a doctor. He chose New York University Medical School, which had a very interesting patient base. Because most patients were indigent, Storch saw a tremendous variety of diseases -- many at advanced stages because of neglect.
After graduating from medical school in 1973, Storch was considering specializing in infectious diseases, and he visited a friend who was working in a program called the Epidemic Intelligence Service (EIS) for the CDC. That visit cinched Storch's desire to work for the CDC. After an internal medicine residency at Washington University School of Medicine, Storch landed a job with the EIS in 1976 and was stationed in New Orleans.
Because of Louisiana's historic problems with yellow fever, Storch said, the state's health department was especially strong. He enjoyed the Cajun culture and found the work fascinating.
"As an EIS officer, I could pretty much work on almost anything I wanted to that had to do with communicable diseases in Louisiana," he said.
He did fieldwork in areas that were experiencing outbreaks of infectious diseases. Storch studied hepatitis, the measles, influenza, histoplasmosis, and Legionnaires' disease, which was discovered during his first week on the job. One of the highlights of the job was a trip to the Marshall Islands, where he worked on an outbreak of bacterial dysentery.
Before leaving the CDC, Storch contacted Gerald Medoff, M.D., then director of the infectious diseases division at the School of Medicine. Accepted for an infectious diseases fellowship, Storch decided to return to St. Louis, his wife's childhood home. Storch and his wife, Deborah, are the parents of four children ranging in age from 15 to 24.
"I think Storch is a very thoughtful, very kind person who relates well to his peers and his patients," Medoff said. "I would regard him as a very good teacher and an excellent role model."
After the fellowship, Storch joined the medical school faculty in 1981 as an assistant professor of pediatrics. His first summer on the Washington University faculty was spent at Baltimore's Johns Hopkins University, where he learned about diagnostic virology. Storch remembers the summer of 1981 vividly because the CDC reported the first five cases of what would be called AIDS.
"It was evident right away, from this report, that this was something very different from anything that had been seen," Storch said. "Not long after, it became clear that AIDS was a large problem that was not going to go away."
When he first entered infectious diseases, Storch said, the field was considered somewhat stagnant. But the discovery of Legionnaires' disease, the first new infectious disease in many years, altered that image. Since 1976, about 20 significant new infectious diseases have been uncovered.
"In retrospect, Legionnaires' disease was a clear signal that there were new diseases out there to uncover. Now, we certainly know that everything that could be discovered hasn't been found yet," he said.
"His research has been outstanding because it really bridges the latest in laboratory research technologies with answering clinical questions," she said. "He's not only diagnosing infectious diseases, but he's also trying to understand the role an infectious agent plays in immune-compromised patients."
David Simpson, M.D., associate professor of neurology and director of the Neuro-AIDS Research Center at New York's Mount Sinai Medical Center, has collaborated with Storch on AIDS research and has consulted with him about complicated and unusual cases.
"I consider him to have the most expertise of anyone in pioneering the assays of spinal fluid," Simpson said. "Also, I've found him to be an extremely enthusiastic and reliable collaborator. He's taken a personal interest in our patients and has followed their progress."
The huge increase in the number of AIDS patients, whose immune systems are suppressed, greatly has expanded the field of infectious diseases, Storch said. He believes physicians will have continued success in treating patients with HIV and that AIDS one day could be a chronic disease that is kept under control with medication.
Storch's work with pediatric AIDS patients spurred him to apply for a grant that helped establish Project ARK, or AIDS/HIV Resources for KIDS, last year. Project ARK helps coordinate medical, psychosocial and educational services for HIV-infected children and their families.
"This grant has allowed us to set up an excellent areawide pediatric HIV/AIDS program," Storch said. "We're better able to care for these children because of Project ARK."
Project ARK, in affiliation with Saint Louis University School of Medicine, now treats about 55 HIV-infected children. In many families, one or both parents and other siblings also are infected.
Kim Donika, Washington University's coordinator for Project ARK, works closely with Storch. She said he is as compassionate and caring as he is skillful. "One thing that stands out to me is how he has worked to support HIV-positive children and their families. He always has made every effort to attend the graveside services of these children," Donika said.
She added that Storch provides the type of leadership that makes everyone on the Project ARK team want to do their best -- just by following his example.
Thomas Roberts, M.D., a fellow in infectious diseases who has chosen Storch as his research mentor, said he has been a terrific adviser. "I feel as if I can approach him with any problem and he'll be helpful. I think he's interested in my views on various clinical subjects as well as research projects," Roberts said.
Berton Roueché's books may have fueled an interest in medical detective work, but Storch also receives great satisfaction from working with people.
"The human aspects of medicine are the most important. Working with patients and helping them cope with disease inspires me to work hard to improve methods for prevention and treatment," he said.
-- Diane Duke
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