Concept of Disease Causation

Germ theory of Disease:

 Germ theory states that many diseases are caused by the
presence and actions of specific micro-organisms.
 It states that microorganisms known as pathogens or "germs"
can lead to disease.
 Louis Pasteur proved that diseases are caused by organisms in
19th century
 The concept of cause emboided in the germ theory of disease is
one-to-one relationship between causal agent and disease:
Disease agent Man Disease
 A diease is rarely caused by a single agent alone, rather depends
on a number of factors which contribute to its occurance.
 Modern medicine has moved beyond from the strict adherance
to the germ theory of disease.
Epidemiological Triad
- The Epidemiological triad
consists of an external agent,
a susceptible host, and an
environment that brings the
host and agent together.
- In this model, disease results
from the interaction between
the agent and the susceptible
host in an environment that
supports transmission of the
agent from a source to that
host.
- Epidemiologic triad or
triangle, the traditional model
for infectious disease.
Epidemiological Triangle
• Based on communicable disease model
• Reflects the interaction of Agent, Host and
Environment
• The Agent—“What”: Is the cause of the
disease.
• The Host—“Who” : Host are organisms, usually
humans or animals, which are exposed to and
harbor a disease.
• The Environment—“Where” The environment
is the favorable surroundings and conditions
external to the host that cause or allow the
disease to be transmitted.
• Time - In the center of the Triangle is time.
Most infectious diseases have an incubation
period—the time between when the host is
infected and when disease symptoms occur. Or,
time may describe the duration of the illness or
the amount of time a person can be sick before
death or recovery occurs. Time also describes
the period from an infection to the threshold of
 Agents
• Agent: It is substance , living or non-living or tangible or intangible,
the excessive presence or relative lack of which may initiate or
perpetuate a disease process.
– Biological agent: Bacteria, virus, protozoa, fungi etc.
– Nutrient agent: Protein, carbohydares, vitamins, minerals etc. Any excess
or deficiency of intake of nutritive elements may result in nutritional
disorders. Anaemia, goitre, obesity, vitamin deficienies etc.
– Physical agents: Exposure to excessive heat, cold, humidity radiation,
sound etc.
– Chemical agents:
• Endogenous exp.: Serum bilirubin (Jundice), calcium carbonate (Kideny stone)
• Exogenous: arise outside human host - allergen, metals, gases, insecticides etc
– Mecahnical agents: Crushing, sprains, dislocations etc.
– Social agents: Smoking, abuse of drugs and alcohol, unhealthy lifestyles
 Host
• Host is usually human or animals who can get the
disease.
• A variety of factors intrinsic to the host, sometimes
called risk factors, can influence an individual’s
exposure, susceptibility, or response to a causative
agent.
• Opportunities for exposure are often influenced by
behaviors and other personal choices as well as by age
and sex.
• Susceptibility and response to an agent are influenced
by factors such as genetic composition, nutritional and
immunologic status, presence of disease or
medications, and psychological makeup.
 Environment
• Environment refers to extrinsic factors that
affect the agent and the opportunity for
exposure.
• Environmental factors include physical factors
such as geology and climate, biologic factors
such as insects that transmit the agent,
socioeconomic factors such as crowding,
sanitation, availability of health services.
 Natural History of Disease
• Natural history of disease refers to the progression of a disease
process in an individual over time, in the absence of treatment.
• Many, if not most, diseases have a characteristic natural history,
although the time frame and specific manifestations of disease
may vary from individual to individual and are influenced by
preventive and therapeutic measures.
 Natural History of Disease

Source: K Park,
 Natural History of Disease
1. Pre Pathogenesis Phase:
• Period preliminary to the onset of disease in man.
• The disease agent has not yet entered man, but the factors
which favour its interaction with the human host are
already existing in the he environment.

Interaction of Agent, Host and Environment

Source: K Park
Natural History of Disease Timeline

Source: Centers for Disease Control and Prevention. Principles of epidemiology,

2nd ed. Atlanta: U.S. Department of Health and Human Services;1992.
Natural History of Disease Timeline
cont...
• The process begins with the
appropriate exposure to or
accumulation of factors
sufficient for the disease
process to begin in a
susceptible host.

• For an infectious disease, the

exposure is a microorganism.

• For cancer, the exposure may

be a factor that initiates the
process, such as asbestos
fibers or components in
tobacco smoke (for lung
cancer)
 Natural History of Disease Timeline
Pathogenesis Phase
• The pathogenesis phase begins with the entry of the
disease "agent" in the susceptible human host.
• The further events in the pathogenesis phase are - the
disease agent multiplies and induces tissue and
physiological changes, the disease progresses through a
period of incubation and later through early and late
pathogenesis.
• The final outcome of the disease may be recovery,
disability or death.
• The pathogenesis phase may be modified by intervention
measures such as immunization and chemotherapy.
Natural History of Disease Timeline
cont...
After the disease process has been
triggered, pathological changes then occur
without the individual being aware of
them.

This stage of subclinical disease, extending

from the time of exposure to onset of
disease symptoms, is usually called the
incubation period for infectious diseases,
and the latency period for chronic
diseases.

During this stage, disease is said to be

asymptomatic (no symptoms) or
inapparent. This period may be as brief as
seconds for hypersensitivity and toxic
reactions to as long as decades for certain
chronic diseases.
Natural History of Disease Timeline
cont...
 Even for a single disease, the
characteristic incubation period has a
range. For example, the typical
incubation period for hepatitis A is as
long as 7 weeks. The latency period for
leukemia to become evident among
survivors of the atomic bomb blast in
Hiroshima ranged from 2 to 12 years,
peaking at 6–7 years.
Natural History of Disease Timeline
cont...
Natural History of Disease Timeline
cont...
Natural History of Disease Timeline
cont...
 After the disease process has been
triggered, pathological changes then
occur without the individual being
aware of them.

 This stage of subclinical disease,

extending from the time of exposure to
onset of disease symptoms, is usually
called the incubation period for
infectious diseases, and the latency
period for chronic diseases.

• During this stage, disease is said to be

asymptomatic (no symptoms) or
inapparent. This period may be as brief
as seconds for hypersensitivity and
toxic reactions to as long as decades
for certain chronic diseases.
 Natural History of Disease Timeline
cont...
• Although disease is not apparent during the
incubation period, some pathologic changes may
be detectable with laboratory, radiographic, or
other screening methods.
• Most screening programs attempt to identify the
disease process during this phase of its natural
history, since intervention at this early stage is
likely to be more effective than treatment given
after the disease has progressed and become
symptomatic.
 Natural History of Disease Timeline
cont...
• The onset of symptoms marks the transition from
subclinical to clinical disease. Most diagnoses are
made during the stage of clinical disease.
• In some people, however, the disease process may
never progress to clinically apparent illness.
• In others, the disease process may result in illness
that ranges from mild to severe or fatal.
• This range is called the spectrum of disease.
Ultimately, the disease process ends either in
recovery, disability or death.
 Terminology
• For an infectious agent, infectivity refers to
the proportion of exposed persons who
become infected.
• Pathogenicity refers to the proportion of
infected individuals who develop clinically
apparent disease.
• Virulence refers to the proportion of clinically
apparent cases that are severe or fatal.