Bio

Clinical Focus


  • Pediatric Infectious Disease

Academic Appointments


Honors & Awards


  • Outstanding Faculty Educator Award, University of Minnesota (2006)
  • Outstanding Faculty Educator Award, University of Minnesota (2004)
  • Pediatric Housestaff Outstanding Fellow's Award, Stanford University (2003)
  • Member, Alpha Omega Alpha (1999)

Professional Education


  • Board Certification: Pediatrics, American Board of Pediatrics (1999)
  • Masters of Science, Univ Minnesota Schl Public Hlth, Clinical Research (2006)
  • Fellowship:Stanford University Medical Center (2003) CA
  • Residency:University of Rochester (1999) NY
  • Medical Education:Baylor College of Medicine (1996) TX
  • Bachelor of Arts, University of Texas at Austin, Biology (1992)
  • Board Certification: Pediatric Infectious Disease, American Board of Pediatrics (2005)

Research & Scholarship

Current Research and Scholarly Interests


My research interest is in viral infections commonly affecting immunocompromised patients, investigating the pathogenesis and anti-viral immunity of these “opportunistic” viruses. I have a special interest in latent and persistent viruses, such as CMV and BK virus, in solid organ transplant patients. I focus on the host immune response to these viral infections with the end goal of improving clinical practices. I collaborate with both individual and core viral and immunology laboratories to conduct my research.

As Co-director of the Pediatric Infectious Diseases Program in Immunocompromised Hosts, I have a research interest in developing and conducting clinical studies to improve identification, treatment and prevention of infectious diseases in the immunocompromised patient population. I also have a scholarly interest in establishing best practices for these patients.

My scholarly work extends to medical education. I am the Co-Chair for a multi-institution microbiology and immunology curriculum development project (with the Robert Wood Johnson Foundation) that aims to re-imagine how medical students gain knowledge in medical school. We are pursuing an innovative approach that involves concepts of the “flipped” classroom. We will be studying the short and long-term outcomes of students who learn from our innovative approach compared to the current standard approach.

Publications

Journal Articles


  • Novel protocol including liver biopsy to identify and treat CD8+ T-cell predominant acute hepatitis and liver failure. Pediatric transplantation McKenzie, R. B., Berquist, W. E., Nadeau, K. C., Louie, C. Y., Chen, S. F., Sibley, R. K., Glader, B. E., Wong, W. B., Hofmann, L. V., Esquivel, C. O., Cox, K. L. 2014; 18 (5): 503-509

    Abstract

    In the majority of children with ALF, the etiology is unknown and liver transplantation is often needed for survival. A patient case prompted us to consider that immune dysregulation may be the cause of indeterminate acute hepatitis and liver failure in children. Our study includes nine pediatric patients treated under a multidisciplinary clinical protocol to identify and treat immune-mediated acute liver injury. Patients with evidence of inflammation and no active infection on biopsy received treatment with intravenous immune globulin and methylprednisolone. Seven patients had at least one positive immune marker before or after treatment. All patients had a CD8+ T-cell predominant liver injury that completely or partially responded to immune therapy. Five of the nine patients recovered liver function and did not require liver transplantation. Three of these patients subsequently developed bone marrow failure and were treated with either immunosuppression or stem cell transplant. This series highlights the importance of this tissue-based approach to diagnosis and treatment that may improve transplant-free survival. Further research is necessary to better characterize the immune injury and to predict the subset of patients at risk for bone marrow failure who may benefit from earlier and stronger immunosuppressive therapy.

    View details for DOI 10.1111/petr.12296

    View details for PubMedID 24930635

  • Longitudinal Kinetics of Cytomegalovirus-specific T-cell Immunity and Viral Replication in Infants with Congenital Cytomegalovirus Infection Journal of the Pediatric Infectious Diseases Society Chen, S. F., Holmes, T. H., Slifer, T., Ramachandran, V., Mackey, S., Hebson, C., Arvin, A. M., Lewis, D. B., Dekker, C. L. 2014

    View details for DOI 10.1093/jpids/piu089

  • BK Polyomavirus Subtype III in a Pediatric Renal Transplant Patient with Nephropathy JOURNAL OF CLINICAL MICROBIOLOGY Kapusinszky, B., Chen, S. F., Sahoo, M. K., Lefterova, M. I., Kjelson, L., Grimm, P. C., Kambham, N., Concepcion, W., Pinsky, B. A. 2013; 51 (12): 4255-4258

    Abstract

    BK polyomavirus (BKV) is an emerging pathogen in immunocompromised individuals. BKV subtype III is rarely identified and has not previously been associated with disease. Here we provide the whole-genome sequence of a subtype III BKV from a pediatric kidney transplant patient with polyomavirus-associated nephropathy.

    View details for DOI 10.1128/JCM.01801-13

    View details for Web of Science ID 000327147100067

    View details for PubMedID 24048534

  • Human Parvovirus B19 in Solid Organ Transplantation AMERICAN JOURNAL OF TRANSPLANTATION Eid, A. J., Chen, S. F. 2013; 13: 201-205

    View details for DOI 10.1111/ajt.12111

    View details for Web of Science ID 000315907900021

    View details for PubMedID 23465012

  • Antiviral CD8 T cells in the control of primary human cytomegalovirus infection in early childhood JOURNAL OF INFECTIOUS DISEASES Chen, S. F., Tu, W. W., Sharp, M. A., Tongson, E. C., He, X. S., Greenberg, H. B., Holmes, T. H., Wang, Z. T., Kemble, G., Manganello, A. M., Adler, S. P., Dekker, C. L., Levvis, D. B., Arvin, A. M. 2004; 189 (9): 1619-1627

    Abstract

    Human cytomegalovirus (CMV) establishes persistent infection, with control of replication thought to be mediated by CMV-specific CD8 T cells. Primary CMV infection commonly affects young children and causes prolonged viral shedding in saliva and urine. We investigated whether this virus-host interaction pattern reflects a developmental deficiency of antiviral CD8 T cell-mediated immunity during childhood. CMV-specific CD8 T cell responses in asymptomatic children with active infection were not different from adults with recent or long-term infection in frequency and functional analyses. High urine CMV concentrations were detected, despite these CMV-specific CD8 T cell responses. We conclude that delayed resolution of primary CMV infection in young children is not caused by a deficient CMV-specific CD8 T cell response. Because these healthy children continue to have local CMV replication, we suggest that CD8 T cells may function primarily to prevent symptomatic, disseminated disease.

    View details for Web of Science ID 000220951300010

    View details for PubMedID 15116298

  • Persistent and selective deficiency of CD4(+) T cell immunity to cytomegalovirus in immunocompetent young children JOURNAL OF IMMUNOLOGY Tu, W. W., Chen, S., Sharp, M., Dekker, C., Manganello, A. M., Tongson, E. C., Maecker, H. T., Holmes, T. H., Wang, Z. T., Kemble, G., Adler, S., Arvin, A., Lewis, D. B. 2004; 172 (5): 3260-3267

    Abstract

    Healthy young children who acquire CMV have prolonged viral shedding into the urine and saliva, but whether this is attributable to limitations in viral-specific immune responses has not been explored. In this study, we found that otherwise immunocompetent young children after recent primary CMV infection accumulated markedly fewer CMV-specific CD4(+) T cells that produced IFN-gamma than did adults. These differences in CD4(+) T cell function persisted for more than 1 year after viral acquisition, and did not apply to CMV-specific IFN-gamma production by CD8(+) T cells. The IFN-gamma-producing CD4(+) T cells of children or adults that were reactive with CMV Ags were mainly the CCR7(low) cell subset of memory (CD45R0(high)CD45RA(low)) cells. The decreased IFN-gamma response to CMV in children was selective, because their CCR7(low) memory CD4(+) T cells and those of adults produced similar levels of this cytokine after stimulation with staphylococcal enterotoxin B superantigen. CD4(+) T cells from children also had reduced CMV-specific IL-2 and CD154 (CD40 ligand) expression, suggesting an early blockade in the differentiation of viral-specific CD4(+) T cells. Following CMV acquisition, children, but not adults, persistently shed virus in urine, and this was observable for at least 29 mo postinfection. Thus, CD4(+) T cell-mediated immunity to CMV in humans is generated in an age-dependent manner, and may have a substantial role in controlling renal viral replication and urinary shedding.

    View details for Web of Science ID 000189186000069

    View details for PubMedID 14978134

  • Pleural Effusion and Fever in an Immunocompromised Patient. JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY Kay, A. W., Itoh, M., Valdez, J., Chen, S. F., Matthew, R., Gans, H. A. 2014

    View details for DOI 10.1093/jpids/piu018

  • Conversion From Tacrolimus/Mycophenolic Acid to Tacrolimus/Leflunomide to Treat Cutaneous Warts in a Series of Four Pediatric Renal Allograft Recipients TRANSPLANTATION Lieuko Nguyen, L., McClellan, R. B., Chaudhuri, A., Alexander, S. R., Chen, S. F., Concepcion, W., Grimm, P. 2012; 94 (5): 450-455

    Abstract

    The challenge of immunosuppression in pediatric renal transplantation is to balance preventing rejection while avoiding infectious complications. A dermatological complication of immunosuppression is viral warts, which cause significant disfigurement and increase the risk of skin malignancy.We present three pediatric and adolescent renal allograft recipients with multiple, recalcitrant verrucae vulgares lesions and one patient with molluscum contagiosum who were switched from mycophenolate mofetil to leflunomide. Teriflunomide metabolite levels were carefully maintained between 50,000 and 100,000 ng/mL to balance its immunosuppressive and antiviral properties. No adverse events requiring discontinuation of leflunomide were encountered.Switching from mycophenolate mofetil to leflunomide successfully cleared verrucae vulgares and molluscum lesions in all four renal transplant patients.The ability to minimize and even resolve warts can improve quality of life by reducing risk of skin malignancies and emotional distress in solid organ transplant patients. Leflunomide is a potential therapeutic option for posttransplantation patients with skin warts because it serves both as an adjunct to the immunosuppressive regimen and an antiviral agent.

    View details for DOI 10.1097/TP.0b013e318264351e

    View details for Web of Science ID 000308668000012

    View details for PubMedID 22960763

  • Mycobacterium bovis disease in a pediatric renal transplant patient PEDIATRIC INFECTIOUS DISEASE JOURNAL Chen, S. F., Gutierrez, K. 2006; 25 (6): 564-566

    Abstract

    We describe a pediatric renal transplant patient with Mycobacterium bovis disease who was successfully treated using an antituberculosis regimen that included rifampin. We discuss the history of M. bovis and the diagnosis and management of M. bovis infection in renal transplant patients.

    View details for DOI 10.1097/01.inf.0000219482.75490.d5

    View details for Web of Science ID 000238432300020

    View details for PubMedID 16732161

  • Staphylococcus aureus decolonization PEDIATRIC INFECTIOUS DISEASE JOURNAL Chen, S. F. 2005; 24 (1): 79-80
  • Acute retinal necrosis syndrome in a child PEDIATRIC INFECTIOUS DISEASE JOURNAL Chen, S., Weinberg, G. A. 2002; 21 (1): 78-80

    Abstract

    We recently cared for an 11-year-old child with acute retinal necrosis syndrome, an ophthalmologic condition characterized by the triad of anterior uveitis, occlusive retinal vasculitis and progressive peripheral retinal necrosis. Acute retinal necrosis syndrome occurs primarily in nonimmunocompromised adults as a result of reactivated herpes simplex or varicella-zoster virus infection. Antiviral and antiinflammatory therapy appears to reduce the incidence of vision-threatening retinal necrosis and involvement of the contralateral eye.

    View details for Web of Science ID 000173306400020

    View details for PubMedID 11791109

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