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Lecture 7
Normal Flora in Health and Disease
Normal Flora
In a healthy human, the internal tissues (e.g.
brain, blood, CSF, muscles) are normally free
of microorganisms
The surface tissues (e.g. skin and mucosa
membranes) are constantly in contact with
environmental microorganisms and become
readily colonised by various microbial species
Normal Flora
The mixture of microorganisms regularly
found at any anatomical site is referred to as
the normal microbiota (the indigenous
microbial population, the microflora, or the
normal flora)
Bacteria make up most of the normal
microbiota, they are emphasised over the
fungi (mainly yeast) and protists
Normal Flora
Reasons to acquire knowledge of normal
human microbiota:
An understanding of the different microorganisms
at particular locations provides greater insight into
the possible infections that might result from injury
to these body sites
A knowledge of the normal microbiota helps the
physician-investigator understand the causes and
consequences of colonisation and growth by
microorganisms normally absent at a specific body
site
Normal Flora
An increased awareness of the role that these
normal microbiota play in stimulating the host
immune response can be gained.
This awareness is important because the immune
system provides protection against potential
pathogens
Normal Flora
Three of the most important types of
symbiotic relationships are commensalism,
mutualism, and parasitism
Within each category the association may be
either ectosymbiotic or endosymbiotic
Normal Flora
One of the most important functions of our
normal flora is to protect us from highly
pathogenic organisms.
For example, in a normal (bacterially inhabited
animal), about 106 Salmonella must be
ingested in order to cause disease.
Normal Flora
However, when an animal has been
maintained in a sterile environment all of its
life (a gnotobiotic animal), the same level of
disease can be produced by as few as 10
Salmonella.
This dramatic difference is simply due to
competition.
Normal Flora
The normal commensal population of microbes
participates in the metabolism of food
products, provides essential growth factors,
protects against infections with highly virulent
microorganisms, and stimulates the immune
response.
The human fetus lives in a protected, sterile
environment,
A newborn is exposed to microbes from others
and environment
Normal Flora
The infants skin is colonised first, followed by
the oropharynx, GI tract, and other mucosal
surfaces
Throughout the life of an individual, this
microbial population continues to change
Changes in health can drastically disrupt the
delicate balance that is maintained among the
heterogeneous organisms coexisting within us
Normal Flora
Exposure of an individual to an organism can
lead to one of three outcomes
The organism can:
Transiently colonise the person
Permanently colonise the person
Produce disease
Disease Formation
The process can result from microbial factors:
e.g. damage to organs caused by the proliferation
of the microbe or the production of toxins or
cytotoxic enzymes)
or the hosts immune response to the organism
Disease Formation
Opportunistic pathogens (organisms that are
typically members of the patients normal
flora) - Staphylococcus aureus, Escherichia coli,
Candida albicans
These organisms do not produce disease in
their normal setting but establish disease
when they are introduced into unprotected,
new sites
Skin
The adult human is covered with
approximately 2 m2 of skin
Commensal microorganisms living on or in the
skin can be either resident (normal) or
transient microbiota
Resident organisms normally grow on or in the
skin
Their presence becomes fixed in well-defined
distribution patterns
Skin
Those that are temporarily present are
transient microorganisms
They usually do not become firmly entrenched
and are unable to multiply
Few microorganisms can penetrate the skin
because its outer layer consists of thick, closely
packed cells called keratinocytes
Continuous shedding of the outer epithelial
cells removes many of those microorganisms
adhering to the skin surface
Skin
The skin surface is not a favourable
environment for microbial colonisation - acidic
pH, high concentration of NaCl, lack of
moisture, and has certain inhibitory substances
Sweat glands release lysozyme (muramidase)
and cathelicidin (antimicrobial peptides)
Oil glands secrete complex lipids that may be
partially degraded by the enzymes from certain
Gram positive bacteria (e.g. Propionibacterium
acnes)
Skin
These bacteria can change the secreted lipids
to unsaturated fatty acids which as oleic acid
that have strong antimicrobial activity against
Gram negative bacteria and some fungi
Some fatty acids are volatile and may be
associated with a strong odour
Most skin bacteria are found on superficial
cells, colonising dead cells, or closely
associated with the oil and sweat glands
Skin
Secretions from oil and sweat glands provide
the water, amino acids, urea, electrolytes, and
specific fatty acids that serve as nutrients
primarily for Staphylococcus epidermidis and
aerobic corynebacteria
Gram negative bacteria generally are found in
the more moist region
The yeasts Pityrosporum ovale and P.
orbiculare normally occur on the scalp
Eye
At birth and throughout human life, a small
number of bacterial commensals are found on
the conjunctiva of the eye
The predominant bacterium is S. epidermis
followed by S. aureus, Haemophilus sp. and S.
pneumoniae
External Ear
The normal microbiota of the external ear
resemble those of the skin, with coagulasenegative staphylococci and Corynebacterium
predominating
Fungi: Aspergillus, Alternaria, Penicillium,
Candida, and Saccharomyces
Mouth
The normal microbiota of the mouth or oral
cavity contains organisms that resist mechanical
removal by adhering to surfaces like the gums
and teeth
The continuous desquamation (shedding) of
epithelial cells also removes microorganisms
Those microorganisms able to colonise the
mouth find a very comfortable environment due
to the availability of water and nutrients, the
suitability of pH and temperature, and the
presence of many other growth factors
Mouth
The oral cavity is colonised by microorganisms
from the surrounding environment within
hours after a human is born
Most microorganisms that invade the oral
cavity initially are aerobes and obligate
anaerobes (Porphyromonas, Prevotella, and
Fusobacterium) become dominant due to the
anoxic nature of the space between the teeth
and gums
Mouth
As the teeth grow, Streptococcus parasanguis
and Streptococcus mutans attach to their
enamel surfaces
Streptococcus salivarius attaches to the buccal
and gingival epithelial surfaces and colonises
the saliva
The presence of these bacteria contributes to
the eventual formation of dental plaque,
caries, gingivitis, and periodontal diseases
Stomach
Owing to the very acidic pH (2 - 3) of the
gastric contents, most microorganisms are
killed
Less than 10 viable bacteria / mL of gastric
fluid
Streptococcus, Staphylococcus, Lactobacillus,
Peptostreptococcus, and yeasts such as
Candida sp.
Small Intestine
The duodenum contains few microorganisms
because of the combined influence of the
stomachs acidic juices and the inhibitory action
of the bile and pancreatic secretions
Gram positive cocci and rods comprise most of
the microbiota
Jejunum - Enterococcus faecalis, lactobacilli,
diphtheroids, and Candida albicans
Ileum - pH becomes more alkaline; anaerobic
Gram negative bacteria and members of the
family Enterobacteriaceae become established
Large Intestine
Has the largest microbial community in the
body (>400 different species; many exist in
large number)
The microbiota consist primarily of anaerobic,
Gram negative bacteria and Gram positive,
spore-forming, and non-sporing rods
Several studies have shown that the ration of
anaerobic to facultative anaerobic bacteria is
approximately 300 to 1
Large Intestine
Yeast (Candida albicans) and certain protozoa
may occur as harmless commensals
Trichomonas hominis, Entamoeba hartmanni,
Endolimax nana, and Iodomoeba butschlii are
common inhabitants
Bacteriodes thetaiontaomicron suits for
survival in the gut, where it is able to degrade
complex dietary polysaccharides
Large Intestine
Methanogenic bacteria are thought to remove
the products of fermentation by converting H2
and CO2 to methane
Various physiological processes move the
microbiota through the colon so an adult
eliminates about 3 x 10 microorganisms daily peristalsis and desquamation of the surface
epithelial cells
Large Intestine
To maintain homeostasis of the microbiota,
the body must continually replace lost
microorganisms
The bacterial population in the human colon
usually doubles once or twice a day
Under normal conditions the resident
microbial community is self-regulating
Large Intestine
Competition and mutualism between different
microorganisms and between the
microorganisms and their host serve to
maintain a status quo
If the intestinal environment change, the
normal microbiota may change greatly
Disruptive factors: stress, altitude change,
starvation, parasitic organisms, diarrhoea, and use
of antibiotics or probiotics
Genitourinary Tract
The upper genitourinary tract (kidneys,
ureters, and urinary bladder) is usually free of
microorganisms
In both female and male, a few bacteria (S.
epidermidis, Enterococcus faecalis, and
Corynebacterium sp.) usually are present in
the distal portion of the urethra
Genitourinary Tract
The adult female genital tract because of its
large surface area and mucous secretions, has
a complex microbiota that constantly changes
the females menstrual cycle
The major microorganisms are the acidtolerant lactobacilli (Lactobacillus acidophilus
or Dderleins bacillus) vaginal pH: 4.4. 4.6
Gaining Access
1. Inhalation
Through respiratory tract (nose or mouth), aerosols,
droplet transmission
The longer the period of exposure, the greater the
risk of inhalation
e.g. influenza virus
2. Ingestion
Through mouth into gastrointestinal tract
e.g. food poisoning, typhoid fever
e.g. of causative agents: Salmonella, Shigella, E. coli,
Vibrio and the virus causing poliomyelitis enter by
being ingested
Description
Fimbriae
Glycocalyx or capsule
Pili
S Layer
Slime Layer
Teichoic and
lipoteichoic acids
Encapsulation
Antigenic mimicry
Antigenic masking
Antigenic shift
Production of antiimmunoglobulin
proteases
6. Destruction of
phagocytes
7. Inhibition of
chemotaxis
8. Inhibition of
phagocytosis
9. Inhibition of
phagolysosome fusion
10. Resistance to
lysosomal enzymes
11. Intracellular
replication
Questions
Define:
i) Normal flora
ii) Opportunistic organisms
iii) Pathogenic organisms
iv) Bacteraemia
v) Septicaemia
Questions
Questions