NORMAL MICROBIAL FLORA OF THE HUMAN BODY

AGNES D. DIMAANO, MD, DPPS

FACT:

Did you know that there are 20 times more bacteria than cells in your body? In fact, at any one
time, you have more bacteria in your body than the total number of people who have ever lived on the
planet. So the next time you step on the bathroom scale, you need to remember that 1 pound of that
weight is not you at all, but the billions of bugs that live in your gut. This may sound alarming, but many
of these organisms are crucial to good health

DEFINITION

“normal flora” microbial– population of microbes that inhabit skin and mucous membranes of
NORMAL & HEALTHY persons

RESIDENT FLORA- fixed types of microorg. regularly found in a given area at a given age; it
promptly reestablish itself once disturbed

TRANSIENT FLORA- consist of non-pathogenic or potentially pathogenic microorgansims that

inhabit skin, mucous membranes for hours/days/weeks

 Derived from the environment and does not establish itself permanently on the
surface

 If normal flora is intact: transient flora insignificant

 If normal flora is disturbed: transient flora may colonize, proliferate and produce
disease

 ROLE OF RESIDENT FLORA

- most microbes present on skin surfaces are commensals

Dependent on physiologic factors: temperature, moisture, presence of nutrients/ inhibitory

substances

Presence is NOT essential to life (“germ-free” animal is possible )

It plays a definite role in the maintenance of health and normal function

  ROLE OF NORMAL FLORA
i.e. NF of intestine - synthesize vitamin K and aid in absorption of nutrients

NF of skin and mucous membranes prevent colonization by pathogens and possible disease
thru “bacterial interference” ( involve competition for receptors/ nutrients/ mutual
inhibition by metabolic or toxic products , mutual inhibition by antibiotic materials or
bacteriocins )

 SUPPRESSION OF NORMAL FLORA

Suppression of NF  creates a partial local void that when filled by organisms from
environment or from other body parts  may behave as opportunists and become pathogens

NF may produce diseases under certain circumstances may become pathogenic when
introduce into the bloodstream or tissues ( if removed from the restrictions of the
environment )

i.e. Strep viridans ( upper resp’y tract) large

# bloodstream  deformed / prosthetic

heart Valves  Infective endocarditis

 RESIDENT FLORA
Bacteroides from large intestine (harmless )  peritoneal cavity/ pelvic tissue (trauma) 

suppuration and septicemia/ bacteremia

 RESIDENT FLORA: HARMLESS OR HARMFUL ?

IMPORTANT MESSAGE: normal resident flora are harmless; may be beneficial in their normal
location IN THE ABSENCE of coincident abnormalities

BUT they may produce disease if introduced into foreign locations in LARGE numbers and if
(+) predisposing factor

 SKIN
Constant exposure to and contact with the environment contain transient microbes

There is constant and well- defined resident flora, modified in different anatomic areas by:

a)secretions

b) habitual wearing of clothing

 c) proximity to mucous membranes

 NORMAL BACTERIAL FLORA OF SKIN

Staphylococcus epidermidis

Staph. aureus ( in small numbers )

Micrococcus species

Nonpathogenic Neisseria species

Alpha hemolytic & non-hemolytic streptococci

Diphtheroids, Enterococci

Propionilbacterium species

Peptostreptococcus species

Small numbers of Candida, Acinetobacter

 NORMAL FLORA OF SKIN

Aerobic and anaerobic diphtheroid bacilli

( eg, Corynebacterium, Propionibacterium )

Nonhemolytic aerobic and nonaerobic staphylococci ( S. epidermidis, S. aureus and

Peptostreptococci )

Gram (+), aerobic, spore forming bacilli ( S. viridans / enterococci )

Gram (-) coliform bacilli and Acinetobacter

Fungi and yeasts, acid fast mycobacteria

 FACTORS THAT HELP ELIMINATE NONRESIDENT FLORA FROM SKIN:

 LOW PH

 FATTY ACIDS IN SEBACEOUS SECRETIONS

 PRESENCE OF LYSOZYME

Neither profuse sweating nor washing and bathing eliminate / or significantly modify the
normal RF
 ** profuse sweating, washing and bathingdoes not eliminate or significantly modify normal
resident flora

** may be diminished by vigorous daily scrubbing with soap containg hexacholorophene

 NF OF URT/ MOUTH
Any amount of the ff: Diphteroids, non-pathogenic Neisseria species, alpha
hemolytic S. epidermidis, non-hemolytic strep, anaerobes

Lesser amts of the ff: yeast, Haemophilus species, pneumococci, S. aureus , gram- neg rods,
Neisseria meningitidis

 NORMAL FLORA OF MOUTH AND UPPER RESPIRATORY TRACT

NOSE- Corynebacteria, staphylococci ( S. epidermidis, S. aureus ), streptococci

MUCOUS MEMBRANES AND MOUTH- may be sterile at birth but may be contaminated by
passage thru birth canal

– S. viridans, Gm (-) diplococci (Neisseria, Moraxella), diphtheroids, anaerobic

spirochete Provotella, Fusobacterium, Rothia/ Capnocytophaga species

( teeth) , Actinomyces ( tonsillar tissues, gingiva of adults ), Yeast ( Candida ) in mouth

 RESPIRATORY TRACT
PHARYNX AND TRACHEA- non-hemolytic and alpha – hemolytic streptococci and Neisseriae;
Staphylococci; diphtheroids; Haemophilus; pneumococci; Mycoplasma and Prevotella

Infections of mouth include Anaerobes

 UPPER RESPIRATORY TRACT

Mucous membranes of mouth/ pharynx- sterile at birth contaminated by passing thru birth
canal within 4-12 hrs after birth Strep viridans become established

When teeth starts to appear anaerobic spirochetes, fusobacterium sp. etc establish
themselves

Small bronchi and alveoli are normally sterile

INFECTIONS OF URT

Infections of mouth and respiratory tract are usually caused by mixed oronasal flora,
including anaerobes
 Aspiration of saliva ( containing anaerobic microbes like Prevotella melaninogenica,
fusobacteria, peptostreptococci )  necrotizing pneumonia, lung abscess, empyema

 ROLE OF NORMAL MOUTH FLORA IN DENTAL CARIES

CARIES- disintegration of teeth beginning at the surface and progressing inward

Surface enamel demineralize effect of acid production of bacterial fermentation  subsequent

decompostition of dentin  bacterial digestion of protein matrix

 PREVENTION OF DENTAL CARIES

Physical removal of plaques

Limitation of sucrose intake

Good nutrition with adequate protein intake

Reduction of acid production by limiting carbohydrates and frequent cleansing

** Fluoride enhance acid resistance of the

enamel

 GIT FLORA

 NORMAL FLORA OF GIT

At birth sterile intestines food given introduction of microorganism

Breastfed infants large # of lactic acid Streptococci and Lactobacillus

( Bifidobacterium)  produce acid from carbohydrates and tolerate pH 5.0

Bottle fed infants more mixed flora ,

↓ lactobacilli

 INTESTINAL FLORA
Over 500 species of microorganism vital to gut structures and function and is ESSENTIAL
for human health

FUNCTIONS: synthesis of micronutrients, fermentation of indigestible substances and

metabolism of proteins, peptides and bile acids

INTESTINAL MICROFLORA
 Maintains natural bacterial equilibrium  MINIMIZES presence of pathogenic microbes
and limit NEGATIVE effects

ALTERATION OF MICROFLORA: predispose to:

 Allergy

 Inflammatory bowel disease

 Necrotizing enterocolitis

 NORMAL FLORA OF GIT

Adult pattern  bowel flora changes

adult esophagus microbes from saliva/

food

Newborn Enterobacteriaceae ( Klebsiella,

Citrobacter, Enterobacter

Stomach’s acidity keep # of microbes at a minimum ( protection from cholera )

pH ↑ ( alkalinization ) ie. Intake of Cimetidine for peptic ulcer  resident flora ↑

Upper intestine- Lactobacilli/ Enterococci

Lower intestine- fecal flora

GIT AND LACTOBACILLUS

DIARRHEA bacterial content ↓

Intestinal stasis bacterial content ↑

ADULT COLON: 96-99% anaerobes ( Bacteroides sp. , Fusobacterium,

Bifidobacterium, Clostridia, Peptostreptococcus )

only 1-4 %  Gram (-) coliforms

( Enterococci, Proteus,

Pseudomonas)
  INTESTINAL BACTERIA

 Synthesize vitamin K, converts bile pigments/ acids, absorbs nutrients

 Produce NH4  hepatic coma

 Antibiotics taken orally suppress the drug susceptible components ( Erythromycin –

aerobes

Metronidazole- anaerobes

Surgery large bowel some protection from infx by accidental spills afterwhich fecal flora ↑
relative resistance to drugs given DRUG RESISTANCE

Drug susceptible organisms replaced by drug resistant organisms

( Staphylococci, enterococci, Proteus, Pseudomonas, Clostridium, yeast)

Feeding of Lactobacillus in large #’s  temporary establishment of the organism in gut and
partial suppression of other gut flora

Anaerobic flora ( Bacteroides, clostridia, Peptostreptococci ) role in abscess formation in

perforated bowels

 GIT and Rectum

Various Enterobacteriaceae except

Salmonella, Shigella, Vibrio and Campylobacter species

Non-dextrose fermenting gram neg rods

Enterococci

S. epidermidis

Alpha hemolytic and nonhemolytic strep

Diphtheroids

S. aureus in small #

Yeast in small numbers

Anaerobes in large numbers

FUNGI AND YEAST

 NORMAL FLORA OF URETHRA
ANTERIOR URETHRA OF MALE/ FEMALE contain small numbers of organisms found on
SKIN, and PERINEUM

These organisms appear in fresh normally voided urine in 100- 10,000/ mL

 GENITALIA
Any of the ff: Corynebacterium species, Lactobacillus species, α hemolytic and nonhemolytic
strep, nonpathogenic Neisseria sp

Ff when mixed and not predominant: enterococci, Enterobacteriaceae and other GRAM neg
rods; S. epidermidis, Candida albicans, other yeasts

Anaerobes ( impt if pure growth: Prevotella, Clostridium, Peptostreptococcus )

 NORMAL FLORA OF GENITALS

Corynebacterium sp., Lactobacillus sp.,  hemolytic and non-hemolytic streptococci, non-
pathogenic Neisseri

Enterobacteriacae, gram (-) rods, S. epidermidis, Candida albicans and other yeasts

Anaerobes ( Prevotella, Clostridium, Peptostreptococci )

**both sex- same organisms, may be seen in normal voided urine in numbers of 10²- 104/ ml

 NORMAL FLORA OF VAGINA

Birth anaerobic bacteria appear and may persist as long as pH is acidic

When pH ↑/ neutral ( upto puberty )- mixed flora

Puberty aerobic/ anaerobic lactobacilli reappear in large #  helps to maintain acid pH thru
the production of acid from CHO ( glycogen)

Administration of drug/ antibiotics suppress lactobacilli cause irritation and inflammation

Menopause lactobacilli ↓-- mixed flora returns

 NORMAL FLORA OF EYE

Diptheroids (Corynebacterium xerosis )

S. epidermidis

Non hemolytic enterococci

 Neisseria and gram (-) bacilli ( Moraxella sp )

** normal flora is normally held in check by flow of tears containing antibacterial Lysozyme

 DISEASE or INFECTION
Occurs if the bacteria or immunologic reactions to their presence cause sufficient harm to
the person

IDENTIFYING BACTERIA

HAVE TO KNOW NORMAL FLORA

NORMAL FLORA- may produce a balance that ensures survival, growth and propagation of
both bacteria and host

 Difficult to show a specific bacterial specie is the cause of a particular disease Koch’s
postulates

 ALTERED NORMAL FLORA

Here are some of the reasons why good bacteria becomes unfit and causes low levels of friendly
bacteria:

 INFECTIOUS PROCESS

 INFECTION
Many bacteria are transmitted from 1 person to another on HANDS

 S. aureus ( in anterior nares ) rub nose pick up S. aureus in hands transfer to

diff. parts of the body another persons infection

 Opportunistic organism are transmitted on hands of hospital personnels

 HANDWASHING IS IMPORTANT!!!!

 PORTALS OF ENTRY OF PATHOGENS

Respiratory

GIT

Genitals

Urinary tract

Abnormal areas of mucous membranes

 INFECTIOUS PROCESS
Once in the body adhere/ attach to host cells multiplication and spread via lymphatics
and bloodstream ( bacteremia ) reach tissues

 Ie. Strep pneumoniae ( nasopharynx )  aspirated in lungs multiplication 

lungs ( pneumonia ) bloodstream  CSF, heart valves, joint spaces
( meningitis, endocarditis, septic arthritis )

INFECTION

INVASION OF HOST CELLS/ TISSUES

Invasiveness- very central to the infectious process

“entry” of bacteria in host cells

Toxin production and other virulence properties are independent of the ability of bacteria
to invade cells and tissues

 ANTIMICROBIAL THERAPY

 INFECTION CONTROL
CAUSE

PREVENTION

 DISEASE PREVENTION

 Probiotics are said to be:

antimicrobial

anticarcinogenic

antidiarrheal

antiallergenic

antioxidant activities

 HEALTH BENEFITS OF PROBIOTICS

Acute infectious diarrhea

Antibiotic- associated diarrhea

 Inflammatory bowel disease

Irritable bowel syndrome

Food allergy

 HEALTH BENEFITS

Necrotizing enterocolitis

Atopic dermatitis

Cancer

Cystic fibrosis

Rheumatoid arthritis

 INDICATIONS AND USAGE

Probiotics have been used with some benefit in the prevention and treatment of ff:
 antibiotic-associated diarrhea

 infectious and viral diarrheas

 rotavirus-induced diarrhea in infants and children

- There is some evidence to support the use of probiotics to re-colonize the vaginas of women with
recurrent vaginitis


RATIONALE

The rationale for use of probiotics is the fact that the body contains a miniature ecology of
microbes, collectively known as the gut flora.

The # of bacterial types and it’s balance by a wide range of circumstances: the use of antibiotics or
other drugs, excess alcohol, stress, disease, exposure to toxic substances, or even the use of
antibacterial soap.

In cases like these, the bacteria that work well with our bodies may decrease in number, an
event which allows harmful competitors to thrive, to the detriment of our health.
 Why do we need “Probiotics”?

Probiotics consist of good bacteria. These hard working (Good) bacteria keeps us healthy by:

increasing the absorption of minerals and vitamins and improving digestion.

Food or vitamins are only useful if they are properly absorbed and digested.

increases absorption of calcium. An important element to prevent osteoporosis

produces vitamin K

supports healthy liver function

normalize bowel elimination problems and promoting regularity

prevents intestinal tract infections like Candida and Helicobacter Pylori ( + stomach ulcer
condition)

assisting in cholesterol management

protects us against harmful bacteria, fungi and viruses. Probiotics are a category of dietary
supplements consisting of beneficial microorganisms. They limit the proliferation of disease-
causing microorganisms by competitive exclusion in the gastrointestinal tract of man and
animals

Prevents antibiotic side-effects

 CHARACTERISTIC OF PROBOTICS
Microbial organism

Remains viable and stable during use and storage to consumption

Able to induce host response as part of intestinal ecosystem

BENEFICIAL to host when consumed

 Bifidobacterium species

 Lactobacillus species

 Streptococcus thermophilus

 yeast

• AN OUNCE OF PREVENTION IS BETTER THAN A POUND OF CURE