THEORIES OF DISEASE CAUSATION

Disease is a dynamic process and it is just opposite to the health. Health denotes perfect harmony and normal functioning of all the body system or state of complete wellness whereas disease denotes disharmony and deviation from normal functioning of various body functioning systems. The following are some of the theories that were believe to be the cause of disease. Germ Theory of Disease Causation, Epidemiological Triad of Disease Causation, Multifactorial Theory of Disease Causation, GERM THEORY

Germ theory states that many diseases are caused by the presence and actions of specific micro-organisms within the body. The theory was developed and gained gradual acceptance in Europe and the United States from the middle 1800s. It eventually superseded existing miasma and contagion theories of disease and in so doing radically changed the practice of medicine. It remains a guiding theory that underlies contemporary biomedicine. Awareness of the physical existence of germs preceded the theory by more than two centuries. Discoveries made by several individuals also pointed the way to germ theory. On constructing his first simple microscope in 1677, Antoni van Leeuwenhoek was surprised to see tiny organisms - which he called animalcules - in the droplets of water he was examining. He made no connection with disease, and although later scientists observed germs in the blood of people suffering from disease, they suggested that the germs were an effect of the disease, rather than the cause. This fitted with the then popular theory of spontaneous generation. The observations and actions of Ignaz Semmelweis, Joseph Lister and John Snow would retrospectively be acknowledged as contributing to the acceptance of germ theory. But it was the laboratory researches of Louis Pasteur in the 1860s and then Robert Koch in the following decades that provided the scientific proof for germ theory. Their work opened the door to research into the identification of diseasecausing germs and potential life-saving treatments. EPIDERMIOLOGIC TRAID OF DISEASE CAUSATION A traditional model of infectious disease causation, known as the Epidemiologic Triad is depicted in Figure 2. The triad consists of an external agent, a host and an environment in which host and agent are brought together, causing the

disease to occur in the host. A vector, an organism which transmits infection by conveying the pathogen from one host to another without causing disease itself, may be part of the infectious process. A classic example of a vector is the Anopheles mosquito. As the mosquito ingests blood from an infected host, it picks up the parasite plasmodium. The plasmodium are harmless to the mosquito. However, after being stored in the salivary glands and then injected into the next human upon which the mosquito feeds, the plasmodium can cause malaria in the infected human. Thus, the Anopheles mosquito serves as a vector for malaria. Another familiar example of a vector are ticks of the genus Ixodes which can be vectors for Lyme disease. In the traditional epidemiologic triad model, transmission occurs when the agent leaves its reservoir or host through a portal of exit, is conveyed by a mode of transmission to enter through an appropriate portal of entry to infect a susceptible host. Transmission may be direct (direct contact host-to-host, droplet spread from one host to another) or indirect (the transfer of an infectious agent from a reservoir to a susceptible host by suspended air particles, inanimate objects (vehicles or fomites), or animate intermediaries (vectors). Figure 2: Epidemiologic Triad of Disease Causation (Historical)

Can the epidemiologic triad can be applied to a disease that not infectious? Consider a smoking-related disease (Figure 3). If smoking (or more specifically, a carcinogen in the smoke of the cigarette) causes the disease, those who manufacture, sell and distribute cigarettes are vectors, bringing the disease-causing agent to the susceptible host. Diagramming the epidemiologic triad also indicates potential interventions to reduce disease in the population. In this example, clean indoor air legislation, advertising potential harm from smoking or establishing workplace smoking cessation programs could change the environment and reduce the exposure of host to agent. Conversely, increased advertising from cigarette manufacturers or increased numbers of vendors would increase exposure of host to agent.

Fig. 3: Epidemiologic Triad Applied to Smoking-related Disease

Thus, the traditional model of disease transmission can be useful to identify areas of potential intervention to reduce disease prevalence, whether infectious or non-infectious.
MULTIFACTORIAL CAUSATION THEORY

Epidemiological theory is not applicable for non infectious and chronic diseases like coronary artery diseases etc. because it has many causes or multiple factors. This theory helps to understand the various associated causative factors, prioritise and plan preventive and plan measures to control the disease.

BODY ADAPTIVE MECHANISM The immune system functions as the bodys defense mechanism against invasion. The term immunity refers to the bodys specific protective response to an invading foreign agent or organism. Immune function is affected by age and by a variety of other factors, such as central nervous system function, emotional status, medications, the stress of illness, trauma, and surgery. Dysfunctions involving the immune system occur across the life span. Many are genetically based; others are acquired. The term immunopathology refers to the study of diseases resulting from dysfunctions within the immune system. Disorders of the immune system may stem from excesses or deficiencies of immunocompetent cells, alterations in the function of these cells, immunologic attack on self-antigens, or inappropriate or exaggerated responses to specific

antigens. To gain insight into immunopathology and the growing number of immunologic-based disorders and to assess and care for people with immunologic disorders, the nurse needs a sound knowledge base of the immune system and how it functions Acquired (adaptive) immunityimmunologic responses acquired during life but not present at birthusually develops as a result of prior exposure to an antigen through immunization (vaccination) or by contracting a disease, both of which generate a protective immune response. Weeks or months after exposure to the disease or vaccine, the body produces an immune response that is sufficient to defend against the disease upon re-exposure to it. The two types of acquired immunity are known as active and passive. In active acquired immunity, the immunologic defences are developed by the persons own body. This immunity generally lasts many years or even a lifetime. Passive acquired immunity is temporary immunity transmitted from another source that has developed immunity through previous disease or immunization. For example, immune globulin and antiserum, obtained from the blood plasma of people with acquired immunity, are used in emergencies to provide immunity to diseases when the risk for contracting a specific disease is great and there is not enough time for a person to develop adequate active immunity. For example, immune globulin may be administered to those exposed to hepatitis. Immunity resulting from the transfer of antibodies from the mother to an infant in utero or through breastfeeding is another example of passive immunity. Active and passive acquired immunity involve humoral and cellular (cell-mediated) immunologic responses REFERENCES Books Abbas, A. K., & Lichtman, A. H. (2001). Basic immunology: Functions and disorders of the immune system. Philadelphia: W. B. Saunders Guyton & Hall Textbook Of Medical Physiology 11th_Edition2 Donna, D. Ignatavicius . Medical Surgical Nursing

RESOURCES AND WEBSITES Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333; (404) 639-3311, (800) 311-3435; http://www.cdc.gov. National Institute of Allergy and Infectious Disease, Office of Communication and Public Liaison, Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD, 20892-2520; http://www.niaid.nih.gov/. National Institutes of Health, Bethesda, Maryland; http://nih.gov. For toll-free information line for NIH departments: http://www.nih.gov/ health/infoline.htm.

Group members 1.KOOMSON SOPHIA 2. ABIGIAL COBBINA 3.AMOATENG ANTWI AGYEI 4. 5.

Index number ED/SHS/13/0176 ED/SHS/13/0117 ED/SHS/13/0196