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The clinical illness promotion factor: a third ingredient.

A S Evans

    The Yale Journal of Biology and Medicine
    |May 1, 1982
    PubMed
    Summary

    The development of clinical illness from disease exposure is poorly understood. A "clinical illness promoting factor" (CIPF) is proposed to explain why some susceptible individuals develop symptoms while others remain asymptomatic.

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    Area of Science:

    • Infectious Disease Epidemiology
    • Host-Pathogen Interactions
    • Disease Pathogenesis

    Background:

    • Host-pathogen interactions often result in subclinical or asymptomatic responses.
    • Factors determining the transition from asymptomatic infection to clinical illness are poorly understood for both acute and chronic diseases.
    • This unknown factor is termed the clinical illness promoting factor (CIPF).

    Purpose of the Study:

    • To highlight the poorly understood factors that precipitate clinical illness in susceptible hosts.
    • To introduce the concept of a clinical illness promoting factor (CIPF) as a critical determinant of disease manifestation.
    • To advocate for further epidemiologic research to identify the CIPF.

    Main Methods:

    • Review of existing knowledge on disease development in specific infections (tuberculosis, EBV, poliomyelitis).
    • Analysis of factors influencing clinical outcomes in viral oncogenesis, chronic diseases, and carcinogen exposure (tobacco).
    • Conceptual framework development proposing a 'third ingredient' (CIPF).

    Main Results:

    • Genetic susceptibility is key in tuberculosis.
    • Age, genetics, and psychosocial factors influence EBV infection severity.
    • Age, exercise, and genetics affect paralysis risk in poliomyelitis.
    • Limited understanding exists for factors driving clinical disease in viral cancers, chronic diseases, and tobacco-related lung cancer.

    Conclusions:

    • The development of clinical illness requires more than just exposure and susceptibility; a CIPF is likely involved.
    • Specific examples illustrate the complex interplay of host and environmental factors in disease progression.
    • Further epidemiologic studies are crucial to identify and characterize the elusive CIPF.

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