NATURAL HISTORY OF DISEASE

Joko Mulyanto CHEM I - 2010

DEFINITION
The progress of a disease process in an individual over time, in the absence of intervention. The process begins with exposure to or accumulation of factors capable of causing disease. Without medical intervention, the process ends with recovery, disability, or death.

CHARACTERISTICS
Most of diseases have its own (usually different) natural history. Its not always understandable for many disease (remain unclear). For the same disease but different individual, the specific manifestation and progress (time frame) of disease can be various. Influenced by preventive and therapeutic measures, host factors, and other factors.

STAGE OF DISEASE

STAGE 1 : SUSCEPTIBILITY
Appropriate exposure to or accumulation of factors sufficient to begin the disease process in a susceptible host. Agents which assist the development of disease exist, but disease has not developed Infectious disease : microorganism Non-infectious (degenerative) disease : risk factors.

STAGE 2: SUBCLINICAL DISEASE

Also known as pre-symptomatic stage . Inapparent pathologic changes follows exposure, ending with the onset of symptoms Changes have occurred, but not clinically detectable yet. Infectious disease: incubation period Chronic (degenerative) disease: latency period

Contd
Vary from seconds to decades for different diseases, usually in a range of period for single disease. Some pathologic change may be detectable by laboratory, radiographic, or others screening method.

STAGE 3 : CLINICAL DISEASE

Marked by clinical signs and or symptoms of the disease. Most of disease diagnosis made in this stage. The progress of disease may vary in individuals depend on agent, host, and other factors. In term of infectious disease, there are three common terms: infectivity, pathogenicity, virulence.

Contd
Infectivity: refers to the proportion of exposed persons who become infected Pathogenicity: refers to the proportion of infected persons who develop clinical disease. Virulence: refers to the proportion of persons with clinical disease who become severely ill or die. Iceberg phenomenon & carrier.

STAGE 4 : RECOVERY, DISABILITY, OR DEATH

Fully recovered, no residual effect. Disability: disease has progressed to the point of causing residual effect. Not fully recovered, functional and or organic change (damage), temporary or permanent.

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