Perjalanan Alamiah Penyakit

dr. Rohmania Setiarini

 Understanding the characteristic natural
history of a disease enables physicians to
anticipate prognosis and to identify
opportunities for prevention and control.
 what is disease?
a type of internal state which is either an
impairment of normal functional abilitythat
is, a reduction of one or more functional
abilities below typical efficiencyor a
limitation on functional ability caused by
environmental agents
(C. Boorse, What is disease? In: Humber M, Almeder RF, eds. Biomedical ethics
reviews. Humana Press, Totowa NJ, 1997, 7-8 (quoted in Temple et al., 2001)

3
 what is disease?

a state that places individuals at

increased risk of adverse consequences

(Temple LKF et al., Defining disease in the genomics era. Science 3 Aug
2001;293:807-808)

4
The natural history of disease refers to the
progression of disease process in an individual over
time, in the absence of intervention.
There are four stages in the natural history of a disease.
These are:
1. Stage of susceptibility
2. Stage of pre-symptomatic (sub-clinical) disease
3. Stage of clinical disease
4. Stage of disability or death
 Natural history of disease

The progress of a disease process in an individual

overtime in the absence of intervention

recovery

Exposure host disease disability

death
 THE NATURAL HISTORY OF A DISEASE

STIMULUS to
HOST REACTION RECOVERY
the HOST

interrelation of
Agent, Host and Latent Period (Pre- Symptoms, with or without Defects,
Environmental symptomatic) Signs(Clinical) Disability
factors

PREPATHOGEN
PERIOD OF PATHOGENESIS
ESIS

Health Promotion
Specific Disability Limitation
Protection Early Diagnosis and Prompt Treatment,
Rehabilitation

PRIMARY SECONDARY
TREATMENT TERTIARY PREVENTION
PREVENTION PREVENTION
(Leavell's Level of Application of Preventive Medicine)
 natural history

Induction time to disease initiation

Incubation time to symptoms (infectious
disease)

10
 INCUBATION PERIOD

The time interval between contact with an agent and

the first clinical evidence of resulting disease

Depends on :
Portal of entry (defense mechanism)
The ability of multiplication (infectivity)
Number of agents
Level of antibody in the host

It varies individually
 Latent period
the time interval from infection to development of
infectiousness
Infectious period
the time during which time the host can infect another
susceptible host
Non-infectious period
the period when the hosts ability to transmit disease to
other hosts ceases
Incubation period
the time interval between infection to development of
clinical disease
 Natural History

Hepatitis A virus in children has low Pathogenicity and low

virulence, since many infected children remain asymptomatic
and few develop severe illness.
In persons with good nutrition and health, measles virus has
high Pathogenicity but low virulence, since almost all infected
persons develop the characteristic rash illness but few develop
the life-threatening presentations of measles, pneumonia, or
encephalitis. In persons with poorer nutrition and health,
measles is a more virulent disease, with mortality as high as 5-
10%.
Finally, rabies virus is both highly pathogenic and virulent, since
virtually 100% of all infected persons (who do not receive
treatment) progress to clinical disease and death.
 Agent with high infectivity and pathogenicity but
low antigenicity will cause a relatively high disease
prevalence in the community

Agent with high infectivity but low pathogenicity

usually produce a mild or sub clinical symptom and
carrier
Natural history of coronary heart disease

Spontaneous Fibrointimal Plaque growth,

Lipid lesion
atherosclerosis lesion occlusion

Chronic Accumulation of Migration & Disruption

minimal injury lipids and proliferation of
monocytes, thrombi
(blood flow, smooth
smoking) toxic products, muscle cells (adulthood)
(youth?) platelet
adhesion (adulthood)
(adolescence)

15
 Chicken pox
an infectious disease caused by the varicella-zoster virus
the latent period for chicken pox is shorter than the
incubation period, so a child with chicken pox becomes
infectious to others before developing symptoms
 TIME

Death

Infection Clinical disease

Susceptible
host Recovery

No infection

Incubation period

Latent Infectious Non-infectious

Exposure Onset
 HIV (AIDS)
latent period relatively short
infectious period occurs (many years) before the onset of
symptoms
 TIME

Death

Infection Clinical disease

Susceptible
host Recovery

No infection

Incubation period

Latent Infectious

Exposure Onset
Malaria
caused by protozoan parasites of the genus Plasmodium
the stages of the parasite that are infective to
mosquitoes occur about 10 days after the development
of symptoms
latent period is around 10 days longer than the
incubation period, so early treatment of symptoms
could have an important effect on transmission
 Natural history of disease
TIME

Death

Infection Clinical disease

Susceptible
host Recovery

No infection

Incubation period

Latent Infectious

Exposure Onset