Departments

Yale Infectious Diseases cares for ambulatory and hospitalized patients with every variety of infectious disease. Specialized services are offered in such areas as traveler’s health, tick-borne diseases, HIV, and related disorders. Research explores such areas as Lyme disease, West Nile and Zika virus, microbial pathogenesis, pneumonia and UTI in older adults, HIV, meningitis, malaria and international health, and nosocomial infections. We are both consultants, working hand-in-hand with referring physicians or groups, and principal caregivers for our patients. Our care is multidisciplinary, involving skilled nurses, dietitians, social workers, and other physicians to deliver the best care possible. Specialized care is offered in the following areas: Hospital-acquired infection control and management Central nervous system infections Fungal infections Hospital epidemiology Traveler's medicine/international health HIV/AIDS Care Lyme disease and tick-borne illnesses Expertise in treating infections in solid organ and stem cell transplants Comprehensive AIDS care and prevention services for people living with and at risk for HIV Multiple observational studies and clinical trial expertise in the study of HIV, HCV, immunology of aging, pneumonia, pseudomonas, tuberculosis (including MDR), urinary tract infections, and tick- and mosquito-borne diseases

Our internationally recognized team of clinicians focuses on treating a wide array of viral, bacterial, and parasitic infections. Through our outpatient clinical services, we diagnose and treat infectious diseases in children from throughout New England and the Mid-Atlantic states. In addition to HIV/AIDS, tuberculosis, and Lyme disease, our doctors are experts in: Acquired and congenital infections in newborns Infections in immunocompromised patients Fungal infections Respiratory tract infections Tropical medicine and parasitology

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

Our goal at the Diabetes Center is to give patients the tools necessary to successfully manage the day-to-day challenges of living with diabetes and prevent long-term diabetes complications. We provide comprehensive management and education for adults with type 1 and type 2 diabetes. We focus on lifestyle interventions and use the latest medications and technologies to improve our patients’ health. We also treat patients with: Pre-diabetes and metabolic syndrome Obesity Polycystic ovarian syndrome Lipid or cholesterol abnormalities Our nationally recognized doctors and nurse practitioners work as a team to address our patients’ needs in managing diabetes and other conditions. We understand that living with diabetes presents challenges. We focus on education and making patients their own advocates. Through the most current and state-of-the-art treatments, we will help them better manage their care. Oral Medications There are several classes of oral diabetes medications that we may prescribe if patients have type 2 diabetes. These medications differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination. Sulfonylureas: These drugs increase the amount of insulin produced by the pancreas. Meglitinides: These drugs rapidly increase the amount of insulin produced by the pancreas. Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in the liver. Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in the intestines. Thiazolidinediones: This agent makes the body more sensitive to insulin. Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by the pancreas after a meal and reduce the amount of glucose produced by the liver. Injection Therapies There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin. The most common injection therapy is insulin, which comes in many different formulations that differ in how fast they work and how long they last. Below is a list of the different types of insulins. Technologies and Experimental Treatments Insulin Pumps: Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the patient. While fasting, patients will administer a low level of continuous “basal” insulin to keep their blood glucose in the normal range. Prior to meals, they will determine a “bolus” of insulin based on the amount of carbohydrates in the meal. Continuous Glucose Monitoring systems (CGM): A CGM is a device that measures glucose under the skin (also known as “interstitial” glucose) every five minutes thr

Our dermatologists are here to help improve the health and appearance of patients’ skin, and to diagnose and treat both benign and malignant skin conditions. We provide specialized care for the full spectrum of skin disorders, including acne, alopecia areata, psoriasis, inherited skin disease, and skin issues arising after organ transplant and during cancer treatment. We are one of two centers in the state with a pigmented lesion clinic, phototherapy center, and cutaneous lymphoma clinic. The clinical research efforts of our dermatologists have contributed significantly to the treatment of skin tumors such as melanomas and cutaneous T-cell lymphomas. We are actively exploring the uses of advanced technologies such as photopheresis, a therapy for life-threatening and debilitating diseases like cutaneous T-cell lymphoma and graft-versus-host disease. A large portion of the department's research is performed through two separate research entities—the Yale SPORE in Skin Cancer Center and the Spitzoid Neoplasm Repository.

Established in 1984 in response to the increasing number of individuals being treated for HIV/AIDS at Yale New Haven Hospital, our AIDS Care Program offers comprehensive services for adults, adolescents, and children with HIV. We provide primary and consultative medical care, counseling and testing, social services, patient and family support groups, and women's health services. Our participating physicians are board certified in internal medicine and infectious disease. In addition to routine diagnosis, treatment and follow-up care, specialty services are available in psychiatry, neurology, hematology, dermatology, women's health, and substance use counseling. Adult patients requiring hospitalization are admitted to an inpatient unit at Yale New Haven Hospital dedicated to the care of patients with HIV and AIDS. We offer clinical trials offering new and promising therapies for HIV and its complications. Individuals enrolling in these programs may receive their continuing care from their own provider or be monitored at the hospital. We hold weekly AIDS conferences to keep up to date on the newest therapies in HIV prevention and public health strategies, as well as to discuss complicated multidisciplinary cases. Our specialized services include: Outpatient, primary, and consultative HIV care Infusion therapies Subspecialty consultation in dermatology, neurology, psychiatry, women's health, and substance abuse Experimental therapies HIV counseling and testing Testing Rapid HIV testing, which is available to adults and teens who are registered with our Primary Care Center and Women’s Center. Early detection is important for better health outcomes. Adult Outpatient Care In addition to comprehensive HIV specialty/primary care, our clinic offers psychiatry/mental health support, social work, nursing, neurology, gynecology, and hepatitis C treatment for those who need it. We offer HIV care for pregnant women in collaboration with Yale obstetric and pediatric services. Pediatric AIDS Care Program We provide specialized medical, nursing, and social care for children and teenagers living with HIV/AIDS, as well as a transitional program for young adults into adult care. We also follow pregnant HIV-positive mothers who are in the care of the Adult Outpatient Clinic, including screening newborns. The Pediatric AIDS Care Clinic is located in the Pediatric Specialty Center at Yale New Haven Children's Hospital. Appointments may be made by calling the YM CARE Center at 1-877-925-3637 (1-877-YALE MDS).

Spondyloarthritis is a group of inflammatory diseases affecting the spine and joints that affects about 2.7 million Americans, or nearly one in every 100 individuals. Disorders in this group include ankylosing spondylitis (also known as axial spondyloarthritis, or axSpA), psoriatic arthritis, arthritis related to Crohn's disease and ulcerative colitis, and reactive arthritis. The most common symptom is chronic low back pain; patients can also have pain and swelling of joints, tendonitis, heel pain, psoriasis, and inflammatory disease of eye called iritis, or uveitis. The Yale Spondyloarthritis Program was established in February 2019 to provide comprehensive care to patients with spondyloarthritis and to conduct research aimed at finding treatment strategies and discovering biomarkers for early and accurate diagnosis and management. Our program provides coordinated care in a wide range of specialties related to Spondyloarthritis. Our team of experts includes rheumatologists, a physical therapist, rehab medicine specialist, spine surgeon, pain specialist (for musculoskeletal disease), as well as dermatologists, a gastroenterologist, ophthalmologist, psychologist, nutritionist, and cardiologist. In addition to providing clinical care, our program emphasizes patient education, support, and involvement. We provide beginner- and advanced-level patient education and offer a patient support group. Our patients are also able to participate in clinical trials. Our team is committed to improving early diagnosis of axial spondyloarthritis—despite the availability of effective medications, patients experience back pain, disability, and poor quality of life due to delayed diagnosis and lack of timely referrals. In fact, the average delay in diagnosis of axSpA is 8 to 11 years. We seek to improve awareness and early diagnosis through education campaigns that include lectures, group discussions, and social media directed at non-rheumatology physicians.

Penicillin allergies are commonly reported throughout the American population, but yet a small percentage of people are actually allergic to the antibiotic. This can be problematic in pregnant women, who often need antibiotics throughout the course of their pregnancy and after delivery. The Allergy, Asthma & Immunology Care in Pregnant Mothers Program identifies Yale Medicine obstetrical patients who report a penicillin allergy and asks them if they would like to visit an allergist to be tested, with the goal of clearing unnecessary penicillin allergies from their medical charts. Penicillin is typically the first antibiotic medication tried for an infection, and if it can’t be used, medical professionals need to try a broader antibiotic, which has increased risks and contributes to antibiotic resistance. And pregnant women who are believed to have penicillin allergies may have higher rates of C-sections and stay longer in the hospital, in addition to other risks. Therefore, it is key for pregnant women to know if they are actually allergic to penicillin, especially since many people who think they have an allergy either never actually had one or they outgrew it. For patients in the Allergy, Asthma & Immunology Care in Pregnant Mothers Program who agree to be tested, the procedure they undergo is typically done during the third trimester and involves a tiny needle poke of penicillin under the skin. If a rash doesn’t appear within 20 minutes, another poke is given. If the skin is still clear after 20 more minutes, the patient receives an oral dose of amoxicillin, a form of penicillin. The woman is carefully monitored in the office. If there is no reaction, she is cleared of the allergy on her medical chart. The program is led by a board-certified allergy and immunology specialist and a high-risk obstetrician-gynecologist. The physicians work with Ob/Gyns throughout Yale Medicine to educate pregnant women about the importance of allergy testing.

Patients with moderate-to-severe psoriasis often require a host of medications to manage their disease. One type in particular—biologics—are highly effective, but they can be complicated to administer. They are also expensive, which means navigating insurance coverage can be difficult and result in treatment delays. The Psoriasis Treatment Program brings together a board-certified medical dermatologist who specializes in psoriasis and a pharmacist from Yale New Haven Hospital Ambulatory Clinical Pharmacy Services who is an expert in psoriasis medication management and coordinating insurance coverage. Together, this dedicated team can manage patients’ care in a seamless fashion, which ensures prompt care. One medical professional focuses on the disease process and treatment selection; the other medication management. In this collaborative model, patients meet with their physician first to discuss a treatment plan and talk separately with the pharmacist. The pharmacist talks in depth with the patient, obtaining a complete medical history and answering all questions related to potential laboratory tests and prescribed medications, which can include injections they self-administer at home, as well as oral and topical treatments. The two points of access mean that patients aren’t condensing all of their questions about their treatment plan into one appointment, and the two medical professionals communicate closely about their psoriasis patients. If one is not available to help, the other can. Patients can work directly with their pharmacist on all issues related to medications, side effects, and insurance coverage in between follow-up appointments with their physician. Having two points of contact allows patients timely access to their medical team as well as their prescribed medications. The program brings together a physician who has expertise in treating psoriasis and a pharmacist with additional training in outpatient care and in dermatologic medications, including those for psoriasis. Managing medications for dermatologic patients is the pharmacist’s full-time job. The pharmacist educates patients about the medications and can obtain insurance coverage and set up home delivery of the medications, taking many hassles and obstacles out of the patient’s hands.

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

The Cutaneous Granulomatous Disorders Program brings together dermatologists, dermatopathologists, and researchers with expertise in the evaluation and treatment of granulomatous disorders of the skin. Granulomatous disorders of the skin include the following diagnoses: Sarcoidosis Granuloma annulare Necrobiosis lipoidica Reactive granulomatous dermatitis Interstitial granulomatous dermatitis Interstitial granulomatous drug (medication) reaction Palisaded neutrophilic and granulomatous dermatitis Necrobiotic xanthogranuloma Rubella granulomas Granulomatous dermatitis, not otherwise specified These conditions lead to skin rashes, which can be very problematic and are frequently life-altering. Individuals affected by these disorders may experience frustration due to the lack of Food and Drug Administration (FDA)-approved treatment modalities. Yale’s Cutaneous Granulomatous Disorders Program recognizes this and works individually with each patient to find the treatment approach that is most suited to their particular situation and individual goals. The program also strives to identify and evaluate new therapies for these disorders. The primary goal of the Cutaneous Granulomatous Disorders Program is to provide optimal care for each patient seen in our specialty clinic, where we take an individualized approach to each patient’s diagnosis and their goals, pairing these with the best treatment options. The program also has several active clinical trials; patients who are interested may have the ability to participate, potentially providing access to some of the latest molecular therapies undergoing evaluation for the treatment of these disorders. Patients may also have an opportunity to participate in other research projects designed to better understand the molecular pathogenesis of these diseases and their effect on patient well-being. Our team was assembled with the goal of bringing together leading experts in cutaneous granulomatous disorders. The physicians in the program include internationally recognized leaders in medical education on cutaneous granulomatous disorders, scientists that have deciphered the underlying immunology of these disorders, individuals that have developed consensus diagnostic criteria for necrobiotic xanthogranuloma, and physicians that have led the evaluation of new treatment approaches for patients with sarcoidosis, granuloma annulare, and necrobiosis lipoidica. Our team also includes dedicated pharmacists with specialized training in the practical and safe use of cutting-edge dermatologic medications, including those used to treat cutaneous granulomatous disorders. The pharmacists have vast expertise in effectively coordinating insurance coverage and are another important point of contact for our patients as they navigate coverage of specialty medications. For patients with sarcoidosis involving the skin, our dermatologists will work closely with their other specialists to identify the optimal treatment approach. Ya

At the Yale Pediatric Infectious Diseases Consultation Program, our internationally recognized team of clinicians focuses on treating a wide array of viral, bacterial, and parasitic infections. Through our outpatient clinical services, we diagnose and treat infectious diseases in children. In addition to HIV/AIDS, tuberculosis, and Lyme disease, our doctors are experts in: Acquired and congenital infections in newborns Infections in immunocompromised patients Fungal infections Respiratory tract infections Tropical medicine and parasitology Transplant ID Outpatient consultations in Infectious Diseases are provided at The Children's Hospital at Yale New Haven, the major teaching hospital of the Yale School of Medicine. Appointments require a referral from a Primary care provider. To schedule a consultation, physicians should call the YM CARE Center at 1-877-925-3637 (1-877-YALE MDS).