Gregory A Storch

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (191)1085.05 Total impact

  • Gregory A Storch
    Clinical Infectious Diseases 08/2015; DOI:10.1093/cid/civ487 · 9.42 Impact Factor
  • The Journal of allergy and clinical immunology 07/2015; DOI:10.1016/j.jaci.2015.06.011 · 11.25 Impact Factor
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    ABSTRACT: We have developed and evaluated a real-time reverse transcription PCR (RT-PCR) assay for detection of human enterovirus D68 (EV-D68) in clinical specimens. This assay was developed in response to the unprecedented 2014 nationwide EV-D68 outbreak associated with severe respiratory illness in the United States. As part of our evaluation of the outbreak, we sequenced and published the genome sequence of the EV-D68 virus circulating in St. Louis, Missouri. This sequence, along with other GenBank® sequences from past EV-D68 occurrences, was used to computationally select a region of EV-D68 appropriate for targeting in a strain-specific RT-PCR assay. The RT-PCR assay amplifies a segment of the VP-1 gene with an analytic limit of detection of 4 copies per reaction, and was more sensitive than commercially available assays that detect enteroviruses and rhinoviruses without distinguishing between the two, including three multiplex respiratory panels approved for clinical use by the FDA. The assay did not detect any other enteroviruses or rhinoviruses tested, and did detect divergent strains of EV-D68, including the first EV-D68 strain (Fermon) identified in California in 1962. This assay should be useful for identifying and studying current and future outbreaks of EV-D68 viruses. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Journal of clinical microbiology 06/2015; DOI:10.1128/JCM.00923-15 · 4.23 Impact Factor
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    Emerging infectious diseases 05/2015; 21(5). DOI:10.3201/eid2105.142033 · 7.33 Impact Factor
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    Emerging infectious diseases 01/2015; 21(1):184-6. DOI:10.3201/eid2101.141605 · 7.33 Impact Factor
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    ABSTRACT: Background Infections with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) remain important in solid organ transplantation. Quantitative viral nucleic acid testing is a major advance to patient management. These assays are limited by a lack of standardization, resulting in viral load measurements that differ among clinical laboratories. The variability in viral load measurements makes interpretation of multicenter clinical trials data difficult. This study compares the current practices in CMV and EBV viral load testing at four large transplant centers participating in multicenter Clinical Trials in Organ Transplantation and the Clinical Trials in Organ Transplantation in Children (CTOT and CTOTC).Methods Viral load testing was performed on well-defined viral preparations according to standard operating procedures at each site.ResultsAmong centers, CMV viral load testing was accurate compared to WHO International Standards and within acceptable variation for this testing method. Epstein-Barr virus viral load data were more variable and less accurate despite the use of international standards.Conclusions These data suggest that comparison of CMV, but not EBV, viral load measurements at these sites is possible using current assays and control standards. Standardization of these assays is facilitated using the WHO International Standards and will allow comparison of viral load results among transplant centers. Assay standardization must be performed prior to initiation of multicenter trials.
    Clinical Transplantation 10/2014; 28(12). DOI:10.1111/ctr.12473 · 1.49 Impact Factor
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    ABSTRACT: Background The Human Microbiome Project (HMP) was undertaken with the goal of defining microbial communities in and on the bodies of healthy individuals using high-throughput, metagenomic sequencing analysis. The viruses present in these microbial communities, the `human virome¿, are an important aspect of the human microbiome that is particularly understudied in the absence of overt disease. We analyzed eukaryotic double-stranded DNA (dsDNA) viruses, together with dsDNA replicative intermediates of single-stranded DNA viruses, in metagenomic sequence data generated by the HMP. 706 samples from 102 subjects were studied, with each subject sampled at up to five major body habitats: nose, skin, mouth, vagina, and stool. Fifty-one individuals had samples taken at two or three time points 30 to 359 days apart from at least one of the body habitats.ResultsWe detected an average of 5.5 viral genera in each individual. At least 1 virus was detected in 92% of the individuals sampled. These viruses included herpesviruses, papillomaviruses, polyomaviruses, adenoviruses, anelloviruses, parvoviruses, and circoviruses. Each individual had a distinct viral profile, demonstrating the high interpersonal diversity of the virome. Some components of the virome were stable over time.Conclusions This study is the first to use high-throughput DNA sequencing to describe the diversity of eukaryotic dsDNA viruses in a large cohort of normal individuals who were sampled at multiple body sites. Our results show that the human virome is a complex component of the microbial flora. Some viruses establish long-term infections that may be associated with increased risk or possibly with protection from disease. A better understanding of the composition and dynamics of the virome may hold important keys to human health.
    BMC Biology 09/2014; 12(1):71. DOI:10.1186/PREACCEPT-4291631291397469 · 7.98 Impact Factor
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    ABSTRACT: Background Human Herpes Virus type-6 (HHV-6) is a significant cause of the febrile illness roseola infantum in young children. Infection with HHV-6 typically causes a self-limited febrile illness, but occasionally is associated with central nervous system manifestations, including febrile seizures and encephalitis. Host factors associated with severe manifestations of HHV-6-associated neurologic disease remain poorly characterized. Case Reports We report two cases of previously healthy young boys with HHV-6-associated encephalitis who developed a progressive, and ultimately fatal, encephalopathy with refractory movement disorder concurrent with acquisition of acute HHV-6 infection. Both children were treated with the antiviral ganciclovir without improvement in their neurologic symptoms, although quantitative HHV-6 PCR of CSF and/or blood confirmed a decline in viral load with treatment. The clinical course in both cases was most consistent with Alpers-Huttenlocher syndrome, given the intractable seizures, developmental regression and, ultimately, death due to liver and renal failure. In support of this, post-mortem analysis identified both children to be compound heterozygotes for mutations in the mitochondrial polymerase γ gene, POLG. Conclusions POLG mutations are associated with Alpers-Huttenlocher syndrome, however no prior studies have examined the role of acute HHV-6 infection in these patients presenting with severe neurologic disease. It is possible the POLG mutation phenotype was unmasked and/or exacerbated by HHV-6 infection in these two patients, potentially contributing to a more rapid clinical deterioration. This report provides new insight into a previously unrecognized association between POLG mutations and poor neurologic outcome following HHV-6 infection.
    Pediatric Neurology 09/2014; 51(3). DOI:10.1016/j.pediatrneurol.2014.04.006 · 1.50 Impact Factor
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    ABSTRACT: The aim of this study was to identify the best practices for the detection of Shiga toxin-producing Escherichia coli (STEC) in children with diarrheal illness treated at a tertiary care center, i.e., sorbitol-MacConkey (SMAC) agar culture, enzyme immunoassay (EIA) for Shiga toxin, or the simultaneous use of both methods. STEC was detected in 100 of 14,997 stool specimens submitted for enteric culture (0.7%), with 65 cases of E. coli O157. Among E. coli O157 isolates, 57 (88%) were identified by both SMAC agar culture and EIA, 6 (9%) by SMAC agar culture alone, and 2 (3%) by EIA alone. Of the 62 individuals with diarrheal hemolytic uremic syndrome (HUS) seen at our institution during the study period, 16 (26%) had STEC isolated from cultures at our institution and 15 (24%) had STEC isolated at other institutions. No STEC was recovered in 31 cases (50%). Of the HUS cases in which STEC was isolated, 28 (90%) were attributable to E. coli O157 and 3 (10%) were attributable to non-O157 STEC. Consistent with previous studies, we have determined that a subset of E. coli O157 infections will not be detected if an agar-based method is excluded from the enteric culture workup; this has both clinical and public health implications. The best practice would be concomitant use of an agar-based method and a Shiga toxin EIA, but a Shiga toxin EIA should not be considered to be an adequate stand-alone test for detection of E. coli O157 in clinical samples.
    Journal of Clinical Microbiology 07/2014; 52(10). DOI:10.1128/JCM.01231-14 · 4.23 Impact Factor
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    ABSTRACT: A current controversy is whether patients with sepsis progress to an immunosuppressed state. We hypothesized that reactivation of latent viruses occurred with prolonged sepsis thereby providing evidence of clinically-relevant immunosuppression and potentially providing a means to serially-monitor patients' immune status. Secondly, if viral loads are markedly elevated, they may contribute to morbidity and mortality. This study determined if reactivation of herpesviruses, polyomaviruses, and the anellovirus TTV occurred in sepsis and correlated with severity. Serial whole blood and plasma samples from 560 critically-ill septic, 161 critically-ill non-septic, and 164 healthy age-matched patients were analyzed by quantitative-polymerase-chain-reaction for cytomegalovirus (CMV), Epstein-Barr (EBV), herpes-simplex (HSV), human herpes virus-6 (HHV-6), and TTV. Polyomaviruses BK and JC were quantitated in urine. Detectable virus was analyzed with respect to secondary fungal and opportunistic bacterial infections, ICU duration, severity of illness, and survival. Patients with protracted sepsis had markedly increased frequency of detectable virus. Cumulative viral DNA detection rates in blood were: CMV (24.2%), EBV (53.2%), HSV (14.1%), HHV-6 (10.4%), and TTV (77.5%). 42.7% of septic patients had presence of two or more viruses. The 50% detection rate for herpesviruses was 5-8 days after sepsis onset. A small subgroup of septic patients had markedly elevated viral loads (>104-106 DNA copies/ml blood) for CMV, EBV, and HSV. Excluding TTV, DNAemia was uncommon in critically-ill non-septic patients and in age-matched healthy controls. Compared to septic patients without DNAemia, septic patients with viremia had increased fungal and opportunistic bacterial infections. Patients with detectable CMV in plasma had higher 90-day mortality compared to CMV-negative patients; p<0.05. Reactivation of latent viruses is common with prolonged sepsis, with frequencies similar to those occurring in transplant patients on immunosuppressive therapy and consistent with development of an immunosuppressive state. Whether reactivated latent viruses contribute to morbidity and mortality in sepsis remains unknown.
    PLoS ONE 06/2014; 9(6):e98819. DOI:10.1371/journal.pone.0098819 · 3.23 Impact Factor
  • Jina Lee · Gregory A Storch
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    ABSTRACT: Multiplex molecular assays now make it possible for clinical laboratories to detect human coronaviruses (HCoV). We investigated the clinical characteristics of HCoV-OC43 and HCoV-NL63 in patients <5 years of age during a recent coronavirus season. Respiratory viruses were detected using a multiplex molecular assay at St. Louis Children`s Hospital starting in November 2012. We analyzed demographic and clinical data from all patients <5 years old with solo detection of HCoV-OC43 (n=52) and HCoV-NL63 (n=44) and for comparison, samples of children with respiratory syncytial virus (RSV), parainfluenza virus (PIV), and picornaviruses. During the study period, HCoV-OC43 (4%) was the 5 and HCoV-NL63 the 8 (2%) most common respiratory virus. Coinfections were detected in 35% and 38% of children with HCoV-OC43 and HCoV-NL63, respectively. Croup was more common with HCoV-NL63 (30%) than with HCoV-OC43 (2%). Lower respiratory tract infection occurred in 33% of children with HCoV-OC43 and 25% of children with HCoV-NL63. Severe illness was less common in HCoV-NL63, HCoV-OC43, and PIV (14%, each) compared with RSV (30%) and picornaviruses (26%) (p=0.055 for HCoVs combined compared with the other respiratory viruses), and occurred mainly in those with underlying medical conditions. Infections caused by HCoV-OC43 and HCoV-NL63 are common and include some with lower respiratory tract involvement and severe disease, especially in children with underlying medical conditions. Overall, a substantial burden of disease associated with both HCoV-OC43 and HCoV-NL63 was observed for hospitalized children younger than 5 years old.
    The Pediatric Infectious Disease Journal 02/2014; 33(8). DOI:10.1097/INF.0000000000000292 · 3.14 Impact Factor
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    ABSTRACT: The prevalence and seasonal distribution of norovirus infection in children is not well defined. In this study, stool specimens from children suspected of having gastroenteritis were evaluated for the presence of norovirus. When tested retrospectively, 17.4% of samples were positive, primarily with Genogroup GII, peaking in fall and winter.
    01/2014; DOI:10.1093/jpids/piu040
  • Vikas R Dharnidharka · Gregory A Storch · Daniel C Brennan
    New England Journal of Medicine 11/2013; 369(19):1858-9. DOI:10.1056/NEJMc1310006#SA2 · 54.42 Impact Factor
  • Xinran Hu · Jinsheng Yu · Seth D Crosby · Gregory A Storch
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    ABSTRACT: Viral infections are common causes of fever without an apparent source in young children. Despite absence of bacterial infection, many febrile children are treated with antibiotics. Virus and bacteria interact with different pattern recognition receptors in circulating blood leukocytes, triggering specific host transcriptional programs mediating immune response. Therefore, unique transcriptional signatures may be defined that discriminate viral from bacterial causes of fever without an apparent source. Gene expression microarray analyses were conducted on blood samples from 30 febrile children positive for adenovirus, human herpesvirus 6, or enterovirus infection or with acute bacterial infection and 22 afebrile controls. Blood leukocyte transcriptional profiles clearly distinguished virus-positive febrile children from both virus-negative afebrile controls and afebrile children with the same viruses present in the febrile children. Virus-specific gene expression profiles could be defined. The IFN signaling pathway was uniquely activated in febrile children with viral infection, whereas the integrin signaling pathway was uniquely activated in children with bacterial infection. Transcriptional profiles classified febrile children with viral or bacterial infection with better accuracy than white blood cell count in the blood. Similarly accurate classification was shown with data from an independent study using different microarray platforms. Our results support the paradigm of using host response to define the etiology of childhood infections. This approach could be an important supplement to highly sensitive tests that detect the presence of a possible pathogen but do not address its pathogenic role in the patient being evaluated.
    Proceedings of the National Academy of Sciences 07/2013; 110(31). DOI:10.1073/pnas.1302968110 · 9.81 Impact Factor
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    Kristine M Wylie · George M Weinstock · Gregory A Storch
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    ABSTRACT: High throughput, deep sequencing assays are powerful tools for gaining insights into virus-host interactions. Sequencing assays can discover novel viruses and describe the genomes of novel and known viruses. Genomic information can predict viral proteins that can be characterized, describe important genes in the host that control infections, and evaluate gene expression of viruses and hosts during infection. Sequencing can also describe variation and evolution of viruses during replication and transmission. This review recounts some of the major advances in the studies of virus-host interactions from the last two years, and discusses the uses of sequencing technologies relating to these studies.
    Current opinion in microbiology 05/2013; 16(4). DOI:10.1016/j.mib.2013.04.006 · 7.22 Impact Factor
  • Rimma Melamed · Gregory A Storch · Barbara B Warner · Phillip I Tarr
    Archives of Disease in Childhood - Fetal and Neonatal Edition 04/2013; 98(4). DOI:10.1136/archdischild-2013-303807 · 3.86 Impact Factor
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    ABSTRACT: Graphium basitruncatum is genetically and morphologically distinct from other Graphium and Scedosporium species, and has been reported only once previously as a cause of human disease. We report a case of Graphium basitruncatum fungemia in a two year old child with dyskeratosis congenita who underwent stem cell transplantation two months prior to infection.
    Medical Mycology Case Reports 12/2012; 1(1):35–38. DOI:10.1016/j.mmcr.2012.05.003
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    ABSTRACT: The Anelloviridae family consists of non-enveloped, circular, single-stranded DNA viruses. Three genera of anellovirus are known to infect humans, named TTV, TTMDV, and TTMV. Although anelloviruses were initially thought to cause non-A-G viral hepatitis, continued research has shown no definitive associations between anellovirus and human disease to date. Using high-throughput sequencing, we investigated the association between anelloviruses and fever in pediatric patients 2-36 months of age. We determined that although anelloviruses were present in a large number of specimens from both febrile and afebrile patients, they were more prevalent in the plasma and nasopharyngeal (NP) specimens of febrile patients compared to afebrile controls. Using PCR to detect each of the three species of anellovirus that infect humans, we found that anellovirus species TTV and TTMDV were more prevalent in the plasma and NP specimens of febrile patients compared to afebrile controls. This was not the case for species TTMV which was found in similar percentages of febrile and afebrile patient specimens. Analysis of patient age showed that the percentage of plasma and NP specimens containing anellovirus increased with age until patients were 19-24 months of age, after which the percentage of anellovirus positive patient specimens dropped. This trend was striking for TTV and TTMDV and very modest for TTMV in both plasma and NP specimens. Finally, as the temperature of febrile patients increased, so too did the frequency of TTV and TTMDV detection. Again, TTMV was equally present in both febrile and afebrile patient specimens. Taken together these data indicate that the human anellovirus species TTV and TTMDV are associated with fever in children, while the highly related human anellovirus TTMV has no association with fever.
    PLoS ONE 11/2012; 7(11):e50937. DOI:10.1371/journal.pone.0050937 · 3.23 Impact Factor
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    ABSTRACT: OBJECTIVE:Fever without an apparent source is common in young children. Currently in the United States, serious bacterial infection is unusual. Our objective was to determine specific viruses that might be responsible.METHODS:We enrolled children aged 2 to 36 months with temperature of 38°C or greater without an apparent source or with definite or probable bacterial infection being evaluated in the St Louis Children's Hospital Emergency Department and afebrile children having ambulatory surgery. Blood and nasopharyngeal swab samples were tested with an extensive battery of virus-specific polymerase chain reaction assays.RESULTS:One or more viruses were detected in 76% of 75 children with fever without an apparent source, 40% of 15 children with fever and a definite or probable bacterial infection, and 35% of 116 afebrile children (P < .001). Four viruses (adenovirus, human herpesvirus 6, enterovirus, and parechovirus) were predominant, being detected in 57% of children with fever without a source, 13% of children with fever and definite or probable bacterial infection, and 7% of afebrile children (P < .001). Thirty-four percent of 146 viral infections were detected only by polymerase chain reaction performed on blood. Fifty-one percent of children with viral infections and no evidence of bacterial infection were treated with antibiotics.CONCLUSIONS:Viral infections are frequent in children with fever without an apparent source. Testing of blood in addition to nasopharyngeal secretions expanded the range of viruses detected. Future studies should explore the utility of testing for the implicated viruses. Better recognition of viruses that cause undifferentiated fever in young children may help limit unnecessary antibiotic use.
    PEDIATRICS 11/2012; 130(6). DOI:10.1542/peds.2012-1391 · 5.30 Impact Factor

Publication Stats

6k Citations
1,085.05 Total Impact Points

Institutions

  • 1987–2015
    • Washington University in St. Louis
      • • Department of Pediatrics
      • • Department of Medicine
      San Luis, Missouri, United States
  • 1999–2010
    • St. Luke's Hospital (MO, USA)
      Сент-Луис, Michigan, United States
  • 2008
    • Johns Hopkins University
      • Department of Pediatrics
      Baltimore, Maryland, United States
  • 2007
    • Mercy Hospital St. Louis
      San Luis, Missouri, United States
  • 2005
    • University of Missouri - Kansas City
      • Division of Pharmacy Practice
      Kansas City, MO, United States
    • University of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
  • 2000
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
    • University of Missouri
      • Veterinary Medical Diagnostic Laboratory
      Columbia, Missouri, United States
  • 1999–2000
    • The Ohio State University
      • Department of Veterinary Biosciences
      Columbus, OH, United States
  • 1997
    • University of Santiago, Chile
      CiudadSantiago, Santiago Metropolitan, Chile
  • 1994
    • Valley Children's Hospital
      Мадера, California, United States