Basic Concept of Disease Process

Dept. Of Community Medicine

School of Medicine UH
 Natural History of Disease
• The processes normally leading to
disease occurrence, before any
intervention, and to course and outcome
of the disease process.
• This process involves three factors:
– The causative agent(s)
– A susceptible host
– The environment
Agent, Host, & Environment
Equilibrium State (John Gordon)

Agent Host

Environment
4 Possibilities of equilibrium state disorder:

1. Increasing of diseases agent ability

2. Increasing of host susceptibility
3. Shifting of environmental quality to lead to
diseases spreading.
4. Changing of environment that increase the host
susceptibility.
1.Increasing of diseases agent ability:
virulensi kuman bertambah atau resistensi
meningkat
HOST

AGENT

ENVIRONMENT
2. Increasing of host susceptibility:
status gizi menurun
AGENT

HOST

ENVIRONMENT
3. Shifting of environmental quality to lead
to diseases spreading:
lingkungan yang kotor
HOST

AGENT

ENVIRONMENT
4. Changing of environment that increase
the host susceptibility:
kepadatan penduduk di daerah kumuh
AGENT

HOST

ENVIRONMENT
Natural History of Disease (Fig 2.1, p. 34)
 The Disease Process

• Pre-pathogenesis
– Susceptible
• Exposure of the host to an agent occurs, disease
has not yet developed
– Adaptation
• Cell and functional system takes a response
 The Disease Process
• Pathogenesis
– Early pathogenesis
• No symptoms, adaptation has been unsuccessful,
pathogenic changes have begun, happens during the
incubation or latency period
– Clinical disease
• Early clinical stage
• Late clinical stage
 Agent

• A factor whose presence causes a disease or

one whose absence causes disease.
– M.Tuberculosis causes TBC
– Lack of Vitamin D, leads to rickets
• Agent
– Physical mechanical force, temperature
– Chemical  gases, fumes, or liquids
– Nutrient  diet
– Biological  all living agent
– Genetic and  from parents to child
– Psychological  stress
 Characteristics of Agent
Affect their Ability to produce disease

• Infectious diseases.
– Infectivity  infection or attack rate
– Pathogenicity and  pathogenicity rate
– Virulence  Case fatality rate
• Non infectious (non-communicable) disease
– Concentration
– Toxicity
– Intensity
– Chronicity and suddenness
– Etc.
 Special Features
Infectious diseases

• A case may also be a risk factor.

• People may be immune
• A case may be a source without being
recognized as a case
• There is sometimes a need for urgency
• Preventive measures (usually) have a good
scientific basis
 Definition
• Incubation/induction:
– A time when organism exposures and multiplies to
sufficient numbers to produce a host reaction and
clinical symptoms.
• Infection period:
– The time period during which a person transmit a
disease
• Latent period:
– The time period from infection until the infectious
period start
 Definition
• Clinical horizon:
– An imaginary line dividing the point where there are
detectable signs and symptoms from that where
there are not.
• Clinical disease:
– Disease that is detectable because of symptoms
experienced by the patient or signs apparent to a
clinical during physical examination.
• Anatomical or functional changes have occurred
 Characteristics of Agent

INFECTIOUS NON-INFECTIOUS
Single necessary No single necessary
Causes are known Causes unknown
Short incubation Long latency
Single exposure Multiple exposure
sufficient sufficient
 Characteristics of Agent

INFECTIOUS NON-INFECTIOUS
1. Produce acute 1. Produce chronic
disease disease
2. Acquired immune 2. Acquired immune
possible unlikely
3. Diagnosed based 3. Diagnosed based
on test specific on test non
specific
 Environment

• All external conditions and influences affecting

the life of living things
– Physical environment
• Water, flora, weather, climate and season
– Socio economic environment
• Sanitation practice
• Medical facilities
• Medical care
• Social stressor
– Biological environment
• Living plants
• Animal
 Host

• Individual human in whom an agent

produces disease
– Immunity
• Humoral (in blood) or cellular (specific)
• Short or long term duration
– Inherent resistance
• General health status
• Good nutrition
 Grafik Riwayat Alamiah Penyakit
Agent sudah berada dalam tubuh host Meninggal
Agent belum Dunia
masuk ke dalam Gejala dapat diobservasi
tubuh host, tapi Kronis
sudah terjadi
kontak antar
keduanya. Bila horison klinis Carrier
terjadi gangguan
pada equilibrium
state, maka agent Gejala tidak dapat diobservasi Sembuh
bisa masuk Agent Cacat
masuk ke Sembuh
dalam Host Sempurna
Masa Masa Inkubasi Masa Penyakit Masa Penyakit Masa Akhir
Prepatogenesis Dini Lanjut Penyakit

Masa Patogenesis
 “Iceberg Phenomenon”
• Spectrum of illness –
most ailments have a
broad range
manifestations &
severities
• We often detect only
the tip of the iceberg
• e.g., dog bite injuries:
SUBCLINICAL CLINICAL
Prepatogenesis
Patogenesis DISEASE
Patological progession
INCEPTION

Mild CLINICAL
Moderate RESPONSE
Typical & Atypical
Severe

Convalescence
SEQULAE
Remission/recurrence
Disability & Deformity
Unremitting progression

DEATH

DISEASES SPECTRUM
Relationship between Disease Manifestation and Disease
Recording and Reporting

Without symptoms Mild Moderate Severe Fatal/Death

Clinical
Symptoms
GP/Hospital and
Recording-Reporting
 FIVE LEVELS OF PREVENTION
Interrelation of Agent, Host, and Environmental factors Reaction of the HOST to the STIMULUS
Early pathogenesis Discernible early Advanced
Production of STIMULUS lesions disease Convalescence

PREPATHOGENESIS PERIOD PERIOD OF PATHOGENESIS

SPECIFIC PROTECTION EARLY DIAGNOSIS and REHABILITATION

HEALTH PROMOTION
• Health education in
Fundamental facts of
Health and disease
• Good standard
of nutrition
• Healthful living habit
• Adequate housing,
recreation,
and agreeable
work conditions
• Avoidance of fatigue
as much as possible
• Attention to personality
development
• Plans for routine specific
immunizations and use of
Booster doses at most
Effective period
• Selective immunization
Based on exposure or
Potential exposure
• Good personal hygiene
• Proper isolation and
quarantine when indicated
• Proper handling of vehicle
Of transmission (food,water)
• Concurrent & terminal
disinfection when indicated
•Satisfactory vector control
• Other environment
Sanitation measures
PROMPT TREATMENT
Case-finding measures,
individual and mass
Screening survey
Selective examinations
Objectives :
To cure and prevent
disease processes
To prevent the spread of
communicable diseases
To prevent complications
and sequel
To shorten period of disability
Examination of contacts
Provision of hospital
and community facilities
for retraining and
DISABILITY LIMITATION
education for
maximum use
of remaining capacities
Adequate treatment
to arrest
Education of the public
the disease process
and industry to utilized
and to prevent
the rehabilitated
further complication
as full employment
and sequel
Selective placement
Provision of
facilities to limit
Work therapy in hospitals
disability
and to prevent death

PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION

LEVELS OF PREVENTION OF COMMUNICABLE DISEASE (LEAVELL & CLARK)

 FIVE LEVELS PREVENTION
(leavell and clark, 1958)

1. Health Promotion
❖ Health education
❖ Good standard of nutrition adjusted to developmental phases of life
❖ Attention to personality development
❖ Provision of adequate housing, recreation and agreeable working conditions
❖ Marriage counseling and sex education
❖ Genetics
❖ Periodics selective examinations
 FIVE LEVELS PREVENTION
(leavell and clark, 1958)

2. Specific Protection
❖ Use of spesific immunizations
❖ Attention to personal hygiene
❖ Use of Environmental sanitation
❖ Protection against occupational hazards
❖ Protection from accidents
❖ Use of spesific nutrients
❖ Protection from carcinogens
❖ Avoidance of allergens
 FIVE LEVELS PREVENTION
(leavell and clark, 1958)

3. Early Diagnosis and Prompt Treatment

❖ Case-finding measures, individual and mass
❖ Screening surveys
❖ Selective examination
Objectives :
▪ To cure and prevent diseases processes
▪ To prevent the spread of communicable diseases
▪ To prevent complications and sequeles
▪ To shorten period of disability
 FIVE LEVELS PREVENTION
(leavell and clark, 1958)

4. Disability Limitation

❖ Adequate treatment to arrest the diseases process and to prevent further

complications and sequeles
❖ Provision of facilities to limit disability and to prevent death
 FIVE LEVELS PREVENTION
(leavell and clark, 1958)

5. Rehabilitation
❖ Provision of hospital and community facilities for retraining and education
for maximum use of remaining capacities
❖ Education of the public and industry to utilize the rehabilitated
❖ As full employment as possible
❖ Selective placement
❖ Work therapy in hospitals
❖ Use of sheltered colony