Disease

A disease is an abnormal condition affecting the body of an organism. It is often construed to be

a medical condition associated with specific symptoms and signs.[1][2][3] It may be caused by
external factors, such as infectious disease, or it may be caused by internal disfunctions, such as
autoimmune diseases. Ecologically, disease is defined as maladjustment of a body with
environment.

In humans, "disease" is often used more broadly to refer to any condition that causes pain,
dysfunction, distress, social problems, and/or death to the person afflicted, or similar problems
for those in contact with the person. In this broader sense, it sometimes includes injuries,
disabilities, disorders, syndromes, infections. Isolated symptoms, deviant behaviors, and atypical
variations of structure and function, while in other contexts and for other purposes these may be
considered distinguishable categories. A diseased body is quite often not only because of some
dysfunction of a particular organ but can also be because of a state of mind of the affected person
who is not at ease with a particular state of its body.

Death due to disease is called death by natural causes. There are four main types of disease:
pathogenic disease, deficiency disease, hereditary disease, and physiological disease.

Stages

In an infectious disease, the incubation period is the time between infection and the appearance
of symptoms. The latency period is the time between infection and the ability of the disease to
spread to another person, which may precede, follow, or be simultaneous with the appearance of
symptoms. Some viruses also exhibit a dormant phase, called viral latency, in which the virus
hides in the body in an inactive state. For example, varicella zoster virus causes chickenpox in
the acute phase; after recovery from chickenpox, the virus may remain dormant in nerve cells for
many years, and later cause herpes zoster (shingles).

A cure is the end of a medical condition or a treatment that is very likely to end it, while
remission refers to the disappearance, possibly temporarily, of symptoms. Complete remission is
the best possible outcome for incurable diseases.

A flare-up can refer to either the recurrence of symptoms or an onset of more severe symptoms.

A refractory disease is a disease that resists treatment, especially an individual case that resists
treatment more than is normal for the specific disease in question.

Scope

A localized disease is one that affects only one part of the body, such as athlete's foot or an eye
infection.
A localized disease is an infectious or neoplastic process that originates in and is confined to one
organ system or general area in the body,[1] such as a sprained ankle, a boil on the hand, an
abscess of finger.

A localized cancer that has not extended beyond the margins of the organ involved can also be
described as localized disease, while cancers that extend into other tissues are described as
invasive. Tumors that are non-hematologic in origin but extend into the bloodstream or
lymphatic system are known as metastatic.

Localized diseases are contrasted with disseminated diseases and systemic diseases.

Some diseases are capable of changing from local to disseminated diseases. Pneumonia, for
example, is generally confined to one or both lungs but can become disseminated through sepsis,
in which the microbe responsible for the pneumonia "seeds" the bloodstream or lymphatic
system and is transported to distant sites in the body. When that occurs, the process is no longer
described as a localized disease, but rather as a disseminated disease.

A disseminated disease has spread to other parts; with cancer, this is usually called metastatic
disease.

Disseminated disease refers to a diffuse disease process, generally either infectious or

neoplastic, but sometimes also referring to connective tissue disease.

A disseminated infection, for example, is one that has extended beyond its origin or nidus and
involved the bloodstream to "seed" other areas of the body. Similarly, metastatic cancer can be
viewed as a disseminated infection in that it has extended into the bloodstream or the lymphatic
system to "seed" distant sites (known as metastasis).

Disseminated disease is often referred to in contrast to localized disease.

A systemic disease is a disease that affects the entire body, such as influenza or high blood
pressure.

A systemic disease is one that affects a number of[ambiguous] organs and tissues, or affects the body as a
whole.[1] Although most medical conditions will eventually involve multiple organs in advanced stage (i.e.
Multiple organ dysfunction syndrome), diseases where multiple organ involvement is at
presentation[ambiguous] or in early stage are considered above.

Infectious disease
An infectious disease is a clinically evident illness resulting from the presence of pathogenic
microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa,
multicellular parasites, and aberrant proteins known as prions. These pathogens are able to cause
disease in animals and/or plants. Infectious pathologies are also called communicable diseases
or transmissible diseases due to their potential of transmission from one person or species to
another by a replicating agent (as opposed to a toxin).[1]

Transmission of an infectious disease may occur through one or more of diverse pathways
including physical contact with infected individuals. These infecting agents may also be
transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or
through vector-borne spread.[2] Transmissible diseases which occur through contact with an ill
person or their secretions, or objects touched by them, are especially infective, and are
sometimes referred to as contagious diseases. Infectious (communicable) diseases which usually
require a more specialized route of infection, such as vector transmission, blood or needle
transmission, or sexual transmission, are usually not regarded as contagious, and thus not are not
as amenable to medical quarantine of victims.

The term infectivity describes the ability of an organism to enter, survive and multiply in the
host, while the infectiousness of a disease indicates the comparative ease with which the disease
is transmitted to other hosts.[3] An infection however, is not synonymous with an infectious
disease, as an infection may not cause important clinical symptoms or impair host function.[2]

Classification

Among the almost infinite varieties of microorganisms, relatively few cause disease in otherwise
healthy individuals.[4] Infectious disease results from the interplay between those few pathogens
and the defenses of the hosts they infect. The appearance and severity of disease resulting from
any pathogen depends upon the ability of that pathogen to damage the host as well as the ability
of the host to resist the pathogen. Infectious microorganisms, or microbes, are therefore
classified as either primary pathogens or as opportunistic pathogens according to the status of
host defenses.

Primary pathogens cause disease as a result of their presence or activity within the normal,
healthy host, and their intrinsic virulence (the severity of the disease they cause) is, in part, a
necessary consequence of their need to reproduce and spread. Many of the most common
primary pathogens of humans only infect humans, however many serious diseases are caused by
organisms acquired from the environment or which infect non-human hosts.

Organisms which cause an infectious disease in a host with depressed resistance are classified as
opportunistic pathogens. Opportunistic disease may be caused by microbes that are ordinarily in
contact with the host, such as pathogenic bacteria or fungi in the gastrointestinal or the upper
respiratory tract, and they may also result from (otherwise innocuous) microbes acquired from
other hosts (as in Clostridium difficile colitis) or from the environment as a result of traumatic
introduction (as in surgical wound infections or compound fractures). An opportunistic disease
requires impairment of host defenses, which may occur as a result of genetic defects (such as
Chronic granulomatous disease), exposure to antimicrobial drugs or immunosuppressive
chemicals (as might occur following poisoning or cancer chemotherapy), exposure to ionizing
radiation, or as a result of an infectious disease with immunosuppressive activity (such as with
measles, malaria or HIV disease). Primary pathogens may also cause more severe disease in a
host with depressed resistance than would normally occur in an immunosufficient host.[2]
One way of proving that a given disease is "infectious", is to satisfy Koch's postulates (first
proposed by Robert Koch), which demands that the infectious agent be identified only in patients
and not in healthy controls, and that patients who contract the agent also develop the disease.
These postulates were first used in the discovery that Mycobacteria species cause tuberculosis.
Koch's postulates cannot be met ethically for many human diseases because they require
experimental infection of a healthy individual with a pathogen produced as a pure culture. Often,
even diseases that are quite clearly infectious do not meet the infectious criteria. For example,
Treponema pallidum, the causative spirochete of syphilis, cannot be cultured in vitro - however
the organism can be cultured in rabbit testes. It is less clear that a pure culture comes from an
animal source serving as host than it is when derived from microbes derived from plate culture.
Epidemiology is another important tool used to study disease in a population. For infectious
diseases it helps to determine if a disease outbreak is sporadic (occasional occurrence), endemic
(regular cases often occurring in a region), epidemic (an unusually high number of cases in a
region), or pandemic (a global epidemic).

Transmission

An infectious disease is transmitted from some source. Defining the means of transmission plays
an important part in understanding the biology of an infectious agent, and in addressing the
disease it causes. Transmission may occur through several different mechanisms. Respiratory
diseases and meningitis are commonly acquired by contact with aerosolized droplets, spread by
sneezing, coughing, talking, kissing or even singing. Gastrointestinal diseases are often acquired
by ingesting contaminated food and water. Sexually transmitted diseases are acquired through
contact with bodily fluids, generally as a result of sexual activity. Some infectious agents may be
spread as a result of contact with a contaminated, inanimate object (known as a fomite), such as a
coin passed from one person to another, while other diseases penetrate the skin directly.[2]

Transmission of infectious diseases may also involve a vector. Vectors may be mechanical or
biological. A mechanical vector picks up an infectious agent on the outside of its body and
transmits it in a passive manner. An example of a mechanical vector is a housefly, which lands
on cow dung, contaminating its appendages with bacteria from the feces, and then lands on food
prior to consumption. The pathogen never enters the body of the fly.

In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new
hosts in an active manner, usually a bite. Biological vectors are often responsible for serious
blood-borne diseases, such as malaria, viral encephalitis, Chagas disease, Lyme disease and
African sleeping sickness. Biological vectors are usually, though not exclusively, arthropods,
such as mosquitoes, ticks, fleas and lice. Vectors are often required in the life cycle of a
pathogen. A common strategy used to control vector borne infectious diseases is to interrupt the
life cycle of a pathogen by killing the vector.

The relationship between virulence and transmission is complex, and has important
consequences for the long term evolution of a pathogen. Since it takes many generations for a
microbe and a new host species to co-evolve, an emerging pathogen may hit its earliest victims
especially hard. It is usually in the first wave of a new disease that death rates are highest. If a
disease is rapidly fatal, the host may die before the microbe can get passed along to another host.
However, this cost may be overwhelmed by the short term benefit of higher infectiousness if
transmission is linked to virulence, as it is for instance in the case of cholera (the explosive
diarrhea aids the bacterium in finding new hosts) or many respiratory infections (sneezing and
coughing create infectious aerosols).

Prevention

One of the ways to prevent or slow down the transmission of infectious diseases is to recognize
the different characteristics of various diseases.[5] Some critical disease characteristics that should
be evaluated include virulence, distance traveled by victims, and level of contagiousness. The
human strains of Ebola virus, for example, incapacitate its victims extremely quickly and kills
them soon after. As a result, the victims of this disease do not have the opportunity to travel very
far from the initial infection zone.[6] Also, this virus must spread through skin lesions or
permeable membranes such as the eye. Thus, the initial stage of Ebola is not very contagious
since its victims experience only internal hemorrhaging. As a result of the above features, the
spread of Ebola is very rapid and usually stays within a relatively confined geographical area. In
contrast, Human Immunodeficiency Virus (HIV) kills its victims very slowly by attacking their
immune system.[2] As a result, many of its victims transmit the virus to other individuals before
even realizing that they are carrying the disease. Also, the relatively low virulence allows its
victims to travel long distances, increasing the likelihood of an epidemic.

Another effective way to decrease the transmission rate of infectious diseases is to recognize the
effects of small-world networks.[5] In epidemics, there are often extensive interactions within
hubs or groups of infected individuals and other interactions within discrete hubs of susceptible
individuals. Despite the low interaction between discrete hubs, the disease can jump to and
spread in a susceptible hub via a single or few interactions with an infected hub. Thus, infection
rates in small-world networks can be reduced somewhat if interactions between individuals
within infected hubs are eliminated (Figure 1). However, infection rates can be drastically
reduced if the main focus is on the prevention of transmission jumps between hubs. The use of
needle exchange programs in areas with a high density of drug users with HIV is an example of
the successful implementation of this treatment method. [6] Another example is the use of ring
culling or vaccination of potentially susceptible livestock in adjacent farms to prevent the spread
of the foot-and-mouth virus in 2001.[7]

General methods to prevent transmission of pathogens may include disinfection and pest control.

Immunity

Infection with most pathogens does not result in death of the host and the offending organism is
ultimately cleared after the symptoms of the disease have waned.[4] This process requires immune
mechanisms to kill or inactivate the inoculum of the pathogen. Specific acquired immunity
against infectious diseases may be mediated by antibodies and/or T lymphocytes. Immunity
mediated by these two factors may be manifested by:

 a direct effect upon a pathogen, such as antibody-initiated complement-dependent

bacteriolysis, opsonoization, phagocytosis and killing, as occurs for some bacteria,
  neutralization of viruses so that these organisms cannot enter cells,
 or by T lymphocytes which will kill a cell parasitized by a microorganism.

The immune system response to a microorganism often causes symptoms such as a high fever
and inflammation, and has the potential to be more devastating than direct damage caused by a
microbe.[2]

Resistance to infection (immunity) may be acquired following a disease, by asymptomatic

carriage of the pathogen, by harboring an organism with a similar structure (crossreacting), or by
vaccination. Knowledge of the protective antigens and specific acquired host immune factors is
more complete for primary pathogens than for opportunistic pathogens.

Immune resistance to an infectious disease requires a critical level of either antigen-specific

antibodies and/or T cells when the host encounters the pathogen. Some individuals develop
natural serum antibodies to the surface polysaccharides of some agents although they have had
little or no contact with the agent, these natural antibodies confer specific protection to adults and
are passively transmitted to newborns.