Normal flora (microbiota)

Recap!
1. Composition and function of nucleic acid
2. the central dogma of life
• Replication, transcription & translation
3. What is spontaneous mutation
4. When and how are genes expressed?
5. What are types of Gene transfer & their
purpose?
6. What is the function of plasmids?
Objectives
1. Define normal flora
2. Differentiate the types or groups of normal flora
3. Explain the basis of normal flora association with
humans
4. Know the different sites of normal flora
5. Know the sterile sites of the human body
6. Explain the role of normal flora in disease
7. Explain the beneficial effects of normal flora
Normal flora
• The population of microorganisms that inhabit the skin and
mucous membranes of healthy normal persons.

• Two groups:
1. The resident flora consists of relatively fixed types of
microorganisms regularly found in a given area at a given
age

2. The transient flora consists of temporary microorganisms

that inhabit the skin or mucous membranes for hours,
days, or weeks
Normal flora
• Resident and transient normal flora

• Normal flora are microorganisms (bacteria, fungi, protozoa,

and viruses), mostly bacteria that continuously inhabit the

human body (Resident Normal Flora).

• Under normal conditions in a healthy human they are

harmless and may even be beneficial.

Normal flora
• A fetus is sterile when born (No Normal Flora)→ acquired from
its mother, air, food and the environment.

• Some internal organs are sterile like the spleen, liver, pancreas,
bladder, CSF, and blood.

• Normal flora differ from one human to another depending on age,

diet, and geographic habitat.

• Reduction in the number of resident normal flora → opportunistic

infections erupt e.g. candidiasis (Candida albicans)
Transient Normal Flora
• Normal flora that are temporarily living on and within
humans.
• The transient microbes living in the external environment
are attracted to moist, warm body areas.
• Temporary microbes because:
1. They may be washed from external areas by bathing.
2. They may not be able to compete with resident normal flora.
3. They may be killed by substances produced by the resident
normal flora.
4. They may not survive in the acidic or alkaline pH of the site.
5. They may be flushed away by bodily secretions like tears, sweat,
oil, urine, feces,..).
 Resident Normal Flora
• Resident normal flora are found in sites exposed to the outside world (external
environment) like the skin, all body openings, and mucous membranes that line
the digestive and genitourinary tracts.

1. Skin

2. Eyes and Ears

3. Respiratory Tract

4. Oral Cavity (Mouth)

5. Gastrointestinal Tract

6. Urogenital Tract
Relationships between Organisms
1. Symbiosis _ Permanent association between two different
organisms.
2. Neutralism _ Two organisms living together, and neither is
affected by that.
3. Commensalism: _ Two organisms living together, one benefits
and the other is not been affected.
4. Mutualism _ Two organisms living together, and both benefit
from that.
5. Parasitism: _ Two organisms living together where one
benefits is ‘’called parasite’’ and the other is harmed ‘’called
host’’.
6. Synergism: _ Sometimes, two (or more) microorganism may
work together “team up” to produce a disease that neither
could cause by itself.
Basis for associations between humans
and normal flora
Factors determining the nature of the normal flora

1. Tissue tropism

2. Specific adherence

3. Microbial construction of biofilms

1. Tissue tropism is the predilection or preference of a microbe for a
specific tissue.

Lactobacilli colonize the vaginal

epithelium because glycogen is produced
there which provides the carbon source
(sugar) for their growth.
EXAMPLES OF TISSUE TROPISM OF SOME BACT ERIA
ASSOCIATED WITH HUMANS

BACTERIUM TISSUE
Corynebacterium diphtheriae Throat
Neisseria gonorrhoeae Urogenital epithelium
Streptococcus mutans Tooth surfaces
Streptococcus salivarius Tongue surfaces
Vibrio cholerae Small intestine epithel ium
Escherichia coli Small intestine epithel ium
Staphylococcus aureus Nasal membranes
Staphylococcus epidermidis Skin
2. Specific adherence is the ability of microbe to attach or adhere to
a specific tissue due to receptor - ligand (adhesin) interactions.
EXAMPLES OF SPECIFIC ATTACHMENTS OF BACTERIA TO
HOST CELL OR TISSUE SURFACES

Bacterial ligand for Host cell or Attachment

Bacterium
attachment tissue receptor site
Streptococcus Amino terminus of Pharyngeal
Protein F
pyogenes fibronectin epithelium
Streptococcus Salivary
Glycosyl transferase Pellicle of tooth
mutans glycoprotein
Buccal
Streptococcus
Lipoteichoic acid Unknown epithelium of
salivarius
tongue
N-
Streptococcus acetylhexosamine - Mucosal
Cell-bound protein
pneumoniae galactose epithelium
disaccharide
Staphylococcus Amino terminus of Mucosal
 3. Biofilms are constructed by some normal flora in order to colonize
tissues.

Example of a biofilm formed by

bacteria in the small intestine
NORMAL FLORA AT DIFFERENT SITES
1. Skin

2. Eyes and Ears

3. Respiratory Tract

4. Oral Cavity (Mouth)

5. Gastrointestinal Tract

6. Urogenital Tract
 SKIN
• Resident bacteria of the skin are mainly bacteria and fungi
and can be in any layer of the skin.
• Aerobic Bacteria:
- Present in the outer layer of skin.
- Staphylococcus epidermidis (accounts 90%)
- Staphylococcus aureus.

• Anaerobic Bacteria: (More than Aerobic bacteria)

- Present in the deeper skin layers, hair follicles, and sweat &
sebaceous glands.
- Propionibacterium acnes.
 Skin (cont..)

• The number and variety of normal flora depends on:

1. Moisture.
2. pH
3. Temperature.
4. Salinity.
5. Chemical waste (urea, fatty acids,..)
6. Other microbes.
• Skin normal flora are generally harmless but it might cause
bloodstream infections if skin is penetrated.
• Healthcare workers should maintain proper hygiene (skin and
clothing) to prevent self infection or transferring infection to
patients.
 Skin
examples:
• Staphylococcus epidermidis
• Staphylococcus aureus (in small numbers)
• Micrococcus species
• Nonpathogenic Neisseria species
• Alpha-hemolytic and nonhemolytic
Streptococci
• Diphtheroids
• Propionibacterium species
• Peptostreptococcus species
• Small numbers of other organisms (Candida
species, Acinetobacter species, etc)
 EYES
• The external surface of the eye is cleaned and
protected by tears, mucus, and oil.

• Tears, that contain lysozyme enzyme, will

reduce the number of normal flora of the eye.

• The conjunctiva of the eye has primarily

Staphylococcus, Streptococcus and
Corynebacterium.
-The conjunctiva covers the white part of the eye and
lines the inside of the eyelids.
 EARS
• The middle ear and inner ear: are usually sterile.

• The outer ear and the auditory canal: contain the same normal
flora of the moist areas like nose and mouth.

• When the person coughs, sneezes, or blows his nose, these

microbes may move into the middle ear where they cause
infection.

• Also infection of the middle ear develops if the Eustachian tube

does not open and close properly to maintain air pressure.
Respiratory Tract

• Upper Respiratory Tract:

• Nose and throat have many microorganisms:
- Normal flora: Corynebacterium (diphtheroids).
- Opportunistic: Staphylococcus, Streptococcus
- Carriers: only in some people have virulent bacteria like C. diphtheriae and S.
pneumoniae.

• Lower Respiratory Tract:

• Is usually sterile because the mucous membranes in lungs remove
any microbes.
 Oral Cavity (Mouth)
• They have both aerobic and anaerobic bacteria.
The most common ones are: C. diphtheroides, S. aureus, S.
epidermidis.

• Also yeasts, molds, protozoa, and viruses can be found in the

mouth.

Teeth and Gingiva: S. mutans

• Poor dental hygiene help bacteria to grow and cause dental
caries, gingivitis,...
• After dental surgeries, there might be a risk of bloodstream
infection that might cause endocarditis.
 Gastrointestinal Tract
• Stomach:
• Only few bacteria are present in the stomach due to gastric enzymes and acidic pH.

• Small intestine:
• Only few normal flora are present in the upper part of small intestine because bile kills them.

• Lower parts have more numbers of normal flora.

• Large intestine:
• Has more bacteria than any other part of the body. 99% of normal flora in the large intestine are

anaerobic Bacteroides spp.

• Also many fungi, protozoa, and viruses can live there.

• Many of the normal flora are opportunistic i.e. if they move to other areas e.g. E.coli cause urinary

infection.
Normal
flora of
the GIT
 Urogenital Tract
• Urinary Tract
• Kidneys, Ureters and Urinary Bladder: are sterile.
• Lower Urethra and external opening: bacteria, yeast, and viruses. Has
the same bacteria present on the skin.

• Genital Organs
• Male and female genitals: are sterile except vagina.
• Vagina: Lactobacillus spp. keeps the pH acidic to protect the vagina
from opportunistic infections e.g. fungal vaginitis (Candida albicans) or
bacterial vaginosis (Bacteroides spp., Gardnerella vaginalis).
Normal flora
of the vagina
SITES OF NORMAL FLORA

30
STERILE BODY SITES

31
 Lower Anterior
BACTERIUM Skin Conjunctiva Nose Pharynx Mouth Vagina
Intestine urethra

Staphylococcus
epidermidis
++ + ++ ++ ++ + ++ ++

Staphylococcus
aureus* + +/- + + + + +/- +

Streptococcus mutans* + ++

Enterococcus faecalis* +/- + ++ + +

Streptococcus
pneumoniae* +/- +/- + + +/-

Streptococcus
pyogenes* +/- +/- + + +/- +/-

Neisseria sp. + + ++ + + +

Neisseria meningitidis* + ++ + +

Enterobacteriaceae*
(Escherichia coli)
+/- +/- +/- + ++ + +

Proteus sp. +/- + + + + + +

++ = nearly 100 percent + = common +/- = variable * = potential pathogen
 Lower Anterior
BACTERIUM Skin Conjunctiva Nose Pharynx Mouth Vagina
Intestine urethra

Pseudomonas
+/- +/- + +/-
aeruginosa*
Haemophilus
influenzae*
+/- + + +

Bacteroides sp.* ++ + +/-

Bifidobacterium
++
bifidum
Lactobacillus sp. + ++ ++ ++

Clostridium sp.* +/- ++

Clostridium
+/-
tetani
Corynebacteria ++ + ++ + + + + +
Mycobacteria + +/- +/- + +
Spirochetes + ++ ++

Mycoplasmas + + + +/- +
++ = nearly 100 percent + = common +/- = variable * = potential pathogen
 Beneficial Functions of Normal Flora
1. Protection from external invaders
• Some normal flora produce peroxides, fatty acids & bacteriocins that kill pathogens and others
compete with them for nutrients.

2. Immune stimulation
• In newborns, normal flora stimulates the development of immune system → T-regulatory cells and
antibodies

3. Production of Vit. K
• Normal flora (E. coli & Bacteroids) of the gut provide important nutrients such as Vitamin K which
aid in digestion and absorption of nutrients.

4. Destruction of Carcinogens
• By the production of certain enzymes, certain chemicals can be modified and denatured
(carcinogens). e.g. Artificial sweeteners may be enzymatically modified
ROLE OF THE NORMAL FLORA IN
DISEASE
• Disease caused by flora reaching sterile sites

• Mouth flora may reach heart valves by transient bacteremia

• Mouth flora plays a major role in dental caries

• Diminished population of normal flora → pathogen to overgrow e.g.

C. difficile growing in the gut after antibiotic therapy

• Compromised defense systems →opportunity pathogens

• Share/transfer antibiotic resistance genes to pathogens →drug

resistance related diseases
overview
Next topic: Modes of disease
transmission by microbes

Thank you!