About

Michael Thomas Czapka, MD, is an infectious disease doctor specializing in treating and preventing infections in immunocompromised adults. He provides care for patients before and after organ transplants, chemotherapy, stem cell transplants, and CAR T-cell therapy, with particular expertise managing fungal and viral infections. Dr. Czapka is actively involved in clinical trials for new drugs and vaccines targeted to difficult-to-treat infections, including fungi and viruses. He also studies infections in CAR T-cell recipients and leads quality improvement initiatives at the hospital. Additionally, Dr. Czapka serves on the institutional ethics review board for clinical research and assists with board exam development within his specialty.

Research topics

• Medicine
• Internal medicine
• Intensive care medicine
• Surgery
• Environmental health
• Immunology
• Gastroenterology
• General surgery

Selected publications

• A case of Heart Transplant After Bartonella henselae Infective Endocarditis Associated with an Implantable Cardioverter-Defibrillator

  SN Comprehensive Clinical Medicine · 2026-05-09

  articleOpen accessSenior author

  Abstract Introduction To our knowledge, only one case of acute Bartonella henselae infective endocarditis treated with heart transplantation as salvage therapy has been published. There is a paucity of literature on management of Bartonella henselae endocarditis in the pre-transplant and post-transplant periods. Case Presentation A 63-year-old Caucasian man with past medical history of heart failure with reduced ejection fraction with implantable cardioverter-defibrillator and HeartMate II left-ventricular assist device was diagnosed with presumptive Bartonella henselae infective endocarditis after presenting with infectious glomerulonephritis. He successfully underwent heart transplant with device removal and was able to discontinue chronic suppressive doxycycline therapy without recurrence of infective endocarditis. Conclusion There remains a paucity of literature on Bartonella henselae endocarditis treated with orthotopic heart transplant and this case report represents the second known case. Our case is also unique in that the patient had endocarditis associated with an implantable cardioverter-defibrillator. We hope it may serve as another resource to guide diagnosis and treatment of Bartonella henselae endocarditis associated with or without cardiac hardware, as well as monitoring for recurrent disease after transplant.

  PublisherOA PDFDOI

• The Effect of a Structural Wellness Intervention on ID Fellows and Faculty

  Journal of Wellness · 2024-11-20

  articleOpen access1st authorCorresponding

  Introduction: Physician burnout is prevalent amongst Infectious Diseases (ID) physicians and trainees in the United States. There is limited data assessing the impact of structural interventions in reducing burnout among medical professionals. Methods: The multifaceted intervention included increased faculty presence over the weekend and faculty support during the week. ID fellows were surveyed before and after the intervention and faculty were surveyed after the intervention using the Maslach Burnout Inventory for Medical Personnel and additional questions regarding wellness and time for education. Pre- and post-intervention responses were compared. Free response answers were analyzed to determine major themes. Metrics of clinical efficiency were recorded before and after intervention as well. Results: 100% of fellows (5) and 70% of faculty (7) participated in surveys. Fellows identified consult volume and pager interruptions as the most common reasons for dissatisfaction prior to the intervention. Following the intervention, 80% of fellows noted improved subjective consult volume (despite service census being slightly larger), as well as other improvements on qualitative analysis of free text responses. Fellows’ post-intervention MBI-HSS(MP) mean emotional exhaustion scores significantly improved (3.3 to 2.3, p = 0.009), while metrics assessing depersonalization (2.4 to 1.9, p = 0.07) and personal accomplishment (4.5 to 4.9, p = 0.06) were not significantly changed. There were no significant differences in survey responses between post-intervention fellows and faculty. For service level metrics post-intervention, we less frequently needed to hold consults overnight until the next day (mean 2.1 to 1.1, p = 0.04). Conclusion: A structural intervention to the ID consultation service was associated with reduced emotional exhaustion amongst fellows and improved perception of clinical volume. Although there was increased workload for faculty there was not a significant difference in markers of burnout or quality of life comparing solely post-intervention responses.

  PublisherDOI

• Pandemic insights: what COVID-19 has revealed about traditional rounding structure

  Discover Social Science and Health · 2023-11-14

  articleOpen access1st authorCorresponding

  Abstract Due to social distancing policies and concerns over patient and provider safety, early in the COVID-19 pandemic many healthcare institutions temporarily converted to various, non-traditional rounding models. The abrupt and unprecedented change in workflow has enabled re-assessment of the reasons for the traditional rounding structures in medical education and comparison to newer strategies for rounding which have developed out of necessity during the pandemic. In this Perspectives article, we examine the positive and negative aspects of rounding models borne out of the pandemic and suggest aspects which may be carried forward, as well as future directions for research.

  PublisherOA PDFDOI

• Phlegmonous gastritis: Evolving from surgical to medical disease

  IDCases · 2023 · 4 citations

  1st authorCorresponding
  • Medicine
  • Intensive care medicine
  • Internal medicine

  with phlegmonous gastritis. We report on a specific successful antimicrobial regimen and duration of therapy, which has not been well documented elsewhere in the literature, which may be helpful to clinicians.

  PublisherDOI

• Infectious complications of car T‐cell therapy: A longitudinal risk model

  Transplant Infectious Disease · 2023 · 12 citations

  1st authorCorresponding
  • Medicine
  • Internal medicine
  • Immunology

  BACKGROUND: CAR T-cell therapy, where a patient's own T cells are re-engineered to express a receptor to a target of interest, is becoming an increasingly utilized cancer-directed therapy. There are significant toxicities that contribute to a novel state of immunocompromise, leading to new patterns of infectious complications that require further detailed study. METHODS: We created a single-center cohort of adult recipients of CD19-directed CAR T-cell therapy and assessed infectious outcomes, supportive care received, toxicities, and markers of immune function up to 2 years following CAR T-cell therapy. Descriptive statistics were used as appropriate for analysis. We additionally conducted time-to-event analysis assessing time-to-first infection with either log-rank testing or Cox regression with univariate analysis, before including significant predictors into a multivariate Cox model of time to infection. RESULTS: We identified 73 patients who received CD19-directed CAR T-cell therapy who predominantly had diffuse large B-cell lymphoma. Within 30 days of cell infusion, bacterial and Candida infections were the most common, with 64% of infections due to these organisms. Between 30 days and 2 years postinfusion, respiratory viruses and pneumonia were the most frequent infections, with 68% of infections due to these etiologies. Receipt of tocilizumab, development of immune effector cell-associated neurotoxicity syndrome (ICANS), or lower neutrophil count were associated with quicker onset of infection in a multivariate Cox model. CONCLUSIONS: Respiratory viruses remain an important infectious complication of CAR T-cell therapy following the first year. The model may be a useful tool to identify patients at the highest risk of infection.

  PublisherOA PDFDOI

• 2721. Respiratory Virus Infections Following CAR T-cell Therapy: Risk Factors and Outcomes

  Open Forum Infectious Diseases · 2023-11-27 · 2 citations

  articleOpen accessSenior author

  Abstract Background Chimeric antigen receptor (CAR) T-cell therapy is a novel cancer therapy which functions by engineering patients’ own cells to target a malignancy. The preparative lymphodepleting chemotherapy and cell versus tumor effect create a novel, dynamic state of immunocompromise. Respiratory viruses have been found to be the predominant late infectious complication, but little is known about specific risk factors and outcomes of these infections. Methods We retrospectively identified adult patients who received CD19-directed CAR T-cell therapy at our center and followed them up to two years post-infusion (or until disease progression, death, or February 2022 — whichever came first). We undertook structured chart review using REDCap. Descriptive statistics were used where indicated. An adapted ordinal scale was used to assess the severity of respiratory virus infections (RVIs) (PMCID: PMC9278199). Results We found 73 patients who met search criteria. Of those, 23 patients (32%) developed an RVI, and their baseline characteristics are listed in Table 1. There were 38 episodes of RVI with an average of 1.65 episodes per affected patient. The median time from infusion to RVI was 180 days. The etiologic agent for the majority of RVIs was either unknown or rhino/enterovirus (Figure 1). The median ordinal score for RVI severity was 1, corresponding to ambulatory management for most (Figure 2). However, 24% of patients required a higher level of care. In patients where serial NAATs were performed, the duration of viral shedding was a median of 33 days (IQR 32 – 39). Immediately prior to infection the median IgG was 370 mg/dl (IQR 292 – 566), ANC was 1690 cells/μL (IQR 873 – 3165), and ALC was 480 cells/μL (IQR 285 – 703). 10 (43%) patients were treated with IVIG and 4 (17%) patients received antivirals. Many patients did not seek care for their RVIs or sought care outside of the Hematology/Oncology clinic. The RVI diagnosis relied on the impression of the treating physician at the time the patient presented with symptoms, or when the patient described past symptoms for which they did not present to the Hematology/Oncology clinic for care. Additionally, sometimes a full panel of respiratory viral nucleic acid amplification testing was done and negative (possibly false negative due to a collection issue or non-tested virus). Other times only COVID/FLU/RSV testing was done. Other times no respiratory virus panel was done. “Unknown” is a clinical syndrome of respiratory viral infection encompassing patients either without nucleic acid amplification testing being performed or with negative testing. The Ordinal Scale for EHR Use* was used to rank the severity of each instance of RVI. Possible rankings included 1, 3, 5, 7, 9, or 11. None of the RVIs met the criteria for 9 (organ support) or 11 (death). *Khodaverdi M, Price BS, Porterfield JZ, Bunnell HT, Vest MT, Anzalone AJ, Harper J, Kimble WD, Moradi H, Hendricks B, Santangelo SL, Hodder SL; N3C Consortium Collaborators. An ordinal severity scale for COVID-19 retrospective studies using Electronic Health Record data. JAMIA Open. 2022 Jul 9;5(3):ooac066. doi: 10.1093/jamiaopen/ooac066. PMID: 35911666; PMCID: PMC9278199. Conclusion There is a high burden of delayed RVI in patients who receive CAR T-cell therapy, and these infections can lead to severe illness requiring hospitalization. Clearance of virus was delayed, with duration of shedding lasting at least one month for most. Many CAR T-cell therapy patients had lower immunoglobulin G and lymphocyte counts prior to RVI. Further research is needed to understand the best treatment and prevention strategies for RVIs in this population. Disclosures All Authors: No reported disclosures

  PublisherOA PDFDOI

• 1290. A Structural Intervention Improves ID Fellow Wellness Amid a Pandemic

  Open Forum Infectious Diseases · 2022-12-01

  articleOpen access1st authorCorresponding

  Abstract Background Infectious Disease (ID) physicians have historically had higher levels of burnout compared to other medical specialties. Fellows are not immune to the pressures that attendings experience in the course of clinical care. The Accreditation Council for Graduate Medical Education now requires programs to formally promote well-being amongst trainees. We created a structural intervention to improve fellow well-being and conducted a before-and-after study demonstrating effectiveness. Methods We restructured our institution’s inpatient ID clinical services, which increased attending presence on weekends and afternoons to help with clinical volume. A survey including the Maslach Burnout Inventory for Medical Personnel (MBI-HSS(MP)) and wellness metrics was completed by our 5 fellows before and after the intervention. Consult volume and efficiency were assessed before and after the intervention. Descriptive statistics, paired t-tests or Wilcoxon signed-rank tests were utilized as appropriate for data normality. Qualitative survey responses were coded into key domains until saturation was reached for analysis. Results Post-intervention MBI-HSS(MP) mean scores significantly improved for emotional exhaustion (EE) [3.3 to 2.3, p-value .0089]. Personal accomplishment and depersonalization metrics improved but were not significant. Survey items assessing time for education, learning to service balance, satisfaction and wellness all improved but were not significant (Table 1). Consult volume was the most frequent domain associated with dissatisfaction, and was described as the most improved domain since intervention (Table 2). Clinical work volumes were the same, if not higher, in the post intervention period (Table 3). All 5 fellows completed surveys before and after the intervention. The pre and post intervention means with standard errors (SE) or frequency of responses are listed in the table as well as p- values for Wilcoxon-signed rank or paired t-test (depending on normality of that variable). For “education versus service balance” fellows used a visual analogue scale (0-100) to assess their views of balance of education (lower values) to service (higher values) while on General Infectious Disease consults (GID). Fellows were asked to rate their “satisfaction” with GID on a visual analogue scale from 0-100 with lower values as dissatisfaction and higher values as satisfaction. EE, DP, and PA are metrics used in the Maslach Burnout Inventory for Medical Personnel (MBI-SS(MP)). The values of the MBI questions are mean responses across items in their respective inventories, with higher values for EE and DP meaning more frequent negative experiences, and higher values for PA meaning more frequent positive experiences. For MBI, scores indicate how frequently feelings occur: 1, a few times/year; 2, monthly; 3, a few times monthly; 4, weekly; 5, a few times/week. Fellows were also asked to give the frequency at which they were able to teach or complete responsibilities at home (such as childcare, cleaning, cooking, grocery shopping) while on GID. Responses truncated only to frequencies selected by respondents. Responses to the last two questions were numerically coded for statistical analysis. * Indicates statistical significance (p < .05). Free text survey responses were analyzed by authors, resulting in the generation of key conceptual response domains; this process continued until saturation was reached, leading to the coding of text responses as above. Examples from text responses included in parenthesis. Prompt 1 was given to the 5 fellows before and after the intervention leading to 10 responses. Prompt 2 was given to the 5 fellows only following intervention. Variables were assessed pre and post intervention. Max list size is the maximum number of patients on the general infectious disease (GID) consult service, bumped consults is the number of consults not seen until the following work day, curbside consults is the number of consults where recommendations were given without seeing the patient, last rec is the time of delivery of the last recommendation, pages is the raw number of pages received in a day by the GID fellow and COVID-19 census is the total number of patients admitted to our center with COVID-19. *Indicates statistical significance (p < .05) by paired t-test. IQR signifies inter-quartile range. Conclusion We found that an intervention addressing structural contributors to burnout was effective in reducing EE and perception of clinical volume. This finding was significant despite stable to increased clinical volumes and the added stress of the cotemporaneous Omicron outbreak of COVID-19. Disclosures Aniruddha Hazra, MD, Gilead Sciences: Grant/Research Support.

  PublisherDOI

• 83. Infectious Outcomes of CAR T-cell Therapy: Longitudinal Follow Up and Risk Stratification

  Open Forum Infectious Diseases · 2022-12-01

  articleOpen access1st authorCorresponding

  Abstract Background Chimeric antigen receptor (CAR) T-cell therapy targeting CD19 is increasingly utilized in the treatment of a variety of hematologic malignancies. While efficacious, this therapy is associated with prolonged cytopenias and immunosuppression. Open questions remain regarding the distribution of infections beyond the first year of therapy and infectious risk stratification. We identified a cohort of CAR T-cell recipients to address these gaps in the literature. Methods We retrospectively analyzed adult patients who received CAR T-cell therapy at our center including their infectious outcomes up to two years following cell infusion. Descriptive statistics and Mann-Whitney testing were used when appropriate. A time-to-event analysis was made assessing time from cell infusion to first infection. Univariate Kaplan-Meier (KM) analyses with log-rank testing and cox regression analysis identified significant predictors for inclusion into a multi-variate cox model of risk of first infection. Results Baseline characteristics of the 75 patients are listed in Table 1. Etiology of infection changed in distribution over time from predominantly nosocomial pathogens more so to respiratory viruses and pneumonia (Figure 1). In univariate KM failure analyses, receipt of tocilizumab or development of neurotoxicity was associated with more rapid onset of first infection (log-rank p-values = 0.0361, 0.0417, respectively) (Figure 2). Multivariate cox regression demonstrated that higher neutrophil count at apheresis was inversely associated with onset of infection (hazard ratio (HR) 0.81; 95% CI .67-.98; p-value .028), while development of neurotoxicity (HR 5.51; 95% CI 1.15–26.5; p-value .033) and receipt of tocilizumab (HR 3.93; 95% CI 1.15–13.42; p-value .029) were associated with onset of infection. Baseline patient population characteristics as described by frequency (n) and percent of total population or median and inter-quartile range (IQR). Abbreviations - CAR: Chimeric Antigen Receptor. ECOG: Eastern Cooperative Oncology Group Performance Score. DLBCL: Diffuse large B cell lymphoma. HGBL: High grade B-cell lymphoma. TFL: Transformed follicular lymphoma. MCL: Mantle-cell lymphoma. PMBCL: Primary mediastinal large B-cell lymphoma. ALL: acute lymphoblastic leukemia. MM: Multiple myeloma. IVIG: Intravenous immune globulin. ANC: Absolute neutrophil count. ALC: Absolute lymphocyte count. IgG: Immunoglobulin G levels. *Indicates missing data on 1 patient, percent relative to n of 74 for these variables. The letter "a" indicates there was one patient each with PMBCL, ALL or MM. Abbreviations - RVI: Respiratory Viral Infection, UTI: Urinary Tract Infection, CDI: Clostridium dificile infection, CAR: Chimeric Antigen Receptor. *Indicates graphical result truncation of RVI number between 30 days and 1-year post-CAR T-cell infusion (n=24), which is the most predominant infection. “Other” infections within 30 days of cell infusion included 2 episodes of cellulitis, and one episode each of sialadenitis, Aspergillus pneumonia and empyema. “Other” infections between 30 days and 1-year post-cell infusion included 1 each of oral HSV, intra-abdominal infection, empyema, conjunctivitis, cellulitis, bacterial sinusitis and tooth abscess. “Other” infections between 1- and 2-years post-cell infusion included shingles and bacterial sinusitis (1 each). Kaplan-Meier failure curves of proportion of patients who developed their first infection (failure) following CAR T-cell infusion by day since cell infusion. Right censoring at two years of follow up, death, or disease progression, whichever came first. A. Curves separated by receipt of tocilizumab (red dashed line) versus no receipt of tocilizumab (solid blue line) during period of follow up. Log-rank test p = 0.0361. B. Curves separated by development of CAR T-cell neurologic toxicity (red dashed line), also known as immune effector cell-associated neurotoxicity syndrome (ICANS) as documented by diagnostic criteria from American Society of Transplant and Cellular Therapy (ASTCT) versus no ICANS (solid blue line). Log-rank test p = 0.0417. Conclusion The pattern of infections following CAR T-cell infusion changes over time, transitioning from nosocomial infections to respiratory viral infections. The multi-variate cox model of time to first infection demonstrated neutropenia at apheresis, tocilizumab receipt and development of neurotoxicity predicted more rapid onset of infection. Strategies to mitigate inflammatory complications may reduce infection. Disclosures All Authors: No reported disclosures.

  PublisherOA PDFDOI

• Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

  Journal of Clinical Medicine · 2020 · 10 citations

  • Medicine
  • Intensive care medicine
  • Environmental health

  infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible "safety net" for these immunocompromised hosts.

  PublisherOA PDFDOI

• Urine trouble: genitourinary tuberculosis and subsequent DRESS syndrome

  BMJ Case Reports · 2017-08-07 · 4 citations

  article1st authorCorresponding

  A 40-year-old woman with HIV (CD4 270, viral load undetectable) from Zambia presented with fevers, urinary tract infection symptoms, sterile pyuria and haematuria. She was found to have genitourinary tuberculosis (TB) via mycobacterial culture of urine and ascites, and treated with rifabutin, isoniazid, pyrazinamide and ethambutol. She later had multiple episodes of asymptomatic transaminitis, triggering changes to both TB and HIV regimens. The patient then presented with diffuse rash, fevers, transaminitis and eosinophilia concerning for drug reaction with eosinophilia and systemic symptoms (DRESS). After initial improvement on discontinuation of likely responsible medications and completion of corticosteroid therapy, the patient returned with acute liver failure. This new episode was felt to be severe organ dysfunction due to DRESS, and she was treated with a prolonged corticosteroid taper and changes to her TB regimen. She has since completed therapy for TB, has improving CD4 counts and is without evidence of liver dysfunction.

  PublisherDOI

Frequent coauthors

• Jennifer Pisano

  University of Chicago

  3 shared

• Christopher Lehmann

  3 shared

• Peter A. Riedell

  University of Chicago

  2 shared

• Erica L. MacKenzie

  2 shared

• John Flores

  2 shared

• Magdalena Slosar-Cheah

  2 shared

• Aniruddha Hazra

  University of Chicago

  2 shared

• Shuchin Shukla

  Mountain Area Health Education Center

  2 shared

Education

• MD

  Albert Einstein College of Medicine, Yeshiva University

  2017

• BS, Biology: Molecular Biology

  Loyola University Chicago

  2013