[CDHC] Syndrome vs. disease revisited

Eric Borneman eborneman at uh.edu
Wed Jun 9 19:05:57 EDT 2004


Great post.  Thank you so much for taking the time to write it.

In preparing my poster on "impairments" from the Flower Garden Banks 
for Okinawa, I took care to try and abide by the progress made at the 
recent meeting.  However, I want to make sure that I am using proper 
terminology.  If I have found an abnormal condition with characteristic 
and consistent identifiable VISUAL signs, but without a known 
etiological agent, what is the proper term?  It seems as though two 
criteria have been met and syndrome/disease is warranted.

And yet, a "birth mark" or a "freckle" has an identifiable group of 
signs and consistent anatomical alterations, yet would this be a 
syndrome or a disease?

When would the terms condition, or impairment be appropriate?  My 
Dorland's medical dictionary does not define either term.

On another note, I have been meaning to write to the list and suggest 
the following reference which also brings up another set of terms and 
which I thought was quite well done, especially since it deals with 

Thomas, Stephen R., and Joseph S. Elkinton. 2004. Pathogenicity and 
virulence. J Invert Path 85: 146-151.

This might be something to upload to the site or have available with 
permission from Elsevier?

Eric Borneman

On Jun 8, 2004, at 11:48 AM, Esther Peters wrote:

> Dear CDHC List Members,
> The Coral Disease and Health Workshop: Developing Diagnostic Criteria 
> that was held in Madison, WI, at the end of April, was an excellent 
> forum in which scientists with diverse backgrounds in the study of 
> corals and diseases came together for many fruitful discussions.  I 
> think we made a lot of progress that week, but I heard about something 
> that happened during the workshop and I felt I should address this 
> topic and express my concerns.  I did not participate in either of the 
> Tuesday afternoon discussion sessions to develop a process to name new 
> coral diseases because I was preparing for the Pathologists' Colloquy. 
>  I understand that in both sessions, use of the terms "disease" and 
> "syndrome" were discussed.  Apparently in both sessions, coral 
> biologists proposed using the term "syndrome" when naming health 
> impairments or lesions when first noticed, i.e., no pathogen 
> (microbial or otherwise) had been identified as the causal agent; then 
> change the name to "disease" when pathogen(s) were identified.  
> Veterinarians noted that both "disease" and "syndrome" are used 
> interchangeably in the biomedical literature for other organisms; if 
> the coral biologists insisted on this naming convention, they would be 
> the first to do so and pathologists would not necessarily recognize 
> this convention.
> I came into the study of diseases of corals and other organisms from 
> the perspective of a biologist/marine scientist, but I have also had 
> the advantage of studying under comparative histopathologists, taking 
> courses in pathology taught by veterinarians (e.g., comparative 
> pathology of laboratory animals at the Armed Forces Institute of 
> Pathology) or human pathologists (at the Foundation for Advanced 
> Education in the Sciences, NIH), I have worked with veterinarians on 
> projects (Registry of Tumors in Lower Animals), and I have had the 
> pleasure of having some of these pathology specialists in my disease 
> courses and slide reading workshops.  They have a lot to teach us and 
> we need to listen.
> I was at a professional meeting a couple of years ago and a 
> comparative pathologist came up to me and mentioned reviewing some NSF 
> proposals and journal manuscripts on coral diseases.  This pathologist 
> was appalled at the lack of knowledge of pathology terminology, 
> disease mechanisms, and misuse of terms in the description of coral 
> lesions and diseases. "Why don't they get it?" I was asked.  This 
> pathologist noted that it was difficult for the scientific community 
> to take the coral biologists seriously when they seemed to be 
> incapable of  applying the body of knowledge of pathology and its 
> terminology to the study of another group of animals.
> Why not?  Having become trained in field and laboratory investigative 
> techniques and terminology so that we can explore coral 
> biology/ecology, perhaps we are not aware that disease investigations 
> require additional understanding of the field of pathology.  Or 
> perhaps we don't have time to pick up a pathology text or medical 
> dictionary.  As an educator in diseases of corals and other organisms, 
> I emphasize to my students that we must learn new definitions and 
> explore the non-coral pathology literature.  I am guilty also:  when I 
> first started out, I used the term "symptoms" in a published paper 
> because I did not know that only humans can report these subjective 
> feelings, in animals we note signs of disease.  But I was informed by 
> others as to that error and joined in trying to make others aware of 
> this (see "Epidemic misuse," E.H. Williams, Jr., L. Bunkley-Williams, 
> J.M. Grizzle, E.C. Peters, D.V. Lightner, J. Harshbarger, A. 
> Rosenfield, and R. Reimschuessel, 1993, Nature 364:664).
> So, I ask the coral biologists, since we have had a wonderful 
> opportunity to interact with and learn from veterinary pathologists 
> through this CDHC workshop, that we take the time to listen and apply 
> their knowledge to our studies.  This will help others accept and 
> understand our work.  The terms "syndrome" and "disease" are used 
> interchangeably (check any medical dictionary).  Criteria for disease 
> include any two of the following:  recognized etiologic agent(s); 
> identifiable group of signs; or consistent anatomical alterations 
> (gross or microscopic).  Thus, we have Alzheimer's disease, when we 
> have no known agent(s); Down's syndrome, caused by triplication or 
> translocation of chromosome 21; or toxic-shock syndrome, caused by 
> toxin-producing staphlococci.  Because many of the impairments and 
> lesions we are examining in the corals consist of an "aggregate of 
> signs...constituting together the picture of disease" using the term 
> "syndrome" is fine.  But, they can also be termed "disease."
> In e-mail discussions with Pam Parnell and Cheryl Woodley, it was 
> noted that field biologists want to be able to give a name to an 
> observation made on the reef and apply a disease/syndrome diagnosis 
> based only on visual signs.  It is important to have identifiers of 
> health impairments seen in the field, but describing a condition is 
> not the same as diagnosing a condition (presumptive or definitive).  
> It is rare in veterinary/human medicine that a set of signs clearly 
> identifies a single disease/syndrome; these are pathognomonic signs, 
> such as those for smallpox.  Most signs of disease can be similar for 
> two or more diseases/syndromes, which require application of 
> appropriate diagnostic tests and procedures before the 
> diseases/syndromes can be differentiated.  Thus, the Public Health 
> Service Web site on case definitions 
> (http://www.cdc.gov/nchstp/od/tuskegee/case_def.htm) defines these 
> categories of disease: suspected case, probable case, clinically 
> compatible case, epidemiologically linked case, supportive or 
> presumptive laboratory results, laboratory-confirmed case confirmed 
> case.  When we report diseases/syndromes based on field signs only, we 
> need to be aware that we are identifying "suspected" or "probable" 
> cases, not "confirmed."  Only with more diagnostic work 
> (histopathology, microbiology, biomarkers, etc.) will we be able to 
> confirm cases as this or that.  As Pam said "The dream of being able 
> to discriminate/differentiate diseases based solely on visual signs in 
> the field is one that has not proven to be attainable in 
> human/veterinary medicine and I believe that with the exception of the 
> RARE few select conditions, the same will hold true for diseases of 
> corals and other invertebrates."
> What will be important is to develop case definitions for the signs of 
> impairment we see in the field under whatever "field condition" 
> disease/syndrome name is assigned, realizing these can change as more 
> knowledge from definitive diagnostic tests becomes available.  
> Preliminary work on the "white syndromes" suggests that these are 
> going to require microbiological and histopathological examinations to 
> distinguish them (white pox, white plague, white band).   Let's listen 
> and learn.
> Esther Peters
> _______________________________________________
> CDHC mailing list
> CDHC at coral.aoml.noaa.gov
> http://coral.aoml.noaa.gov/mailman/listinfo/cdhc

Eric Borneman

More information about the CDHC mailing list