Normal Microflora of

the Human Body

 INTRODUCTION
• •In a healthy human the internal tissues (e.g., brain, blood, cerebrospinal
fluid, muscles) are normally free of microorganisms.
• The surface tissues (e.g., skin and mucous membranes) are constantly in
contact with environmental microorganisms and become readily colonized
by certain microbial species.
• 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.
DISTRIBUTION OF NORMAL HUMAN
MICROBIOTA
 SKIN
• The adult human is covered with approximately 2 square meters of skin.
• It has been estimated that this surface area supports about 1012 bacteria.
• The anatomy and physiology of the skin vary from one part of the body to
another, and the normal resident microbiota reflect these variations
• The skin surface or epidermis is not a favorable environment for microbial
colonization.
• Several factors are responsible for this hostile microenvironment

(1) The skin is subject to periodic drying. Lack of moisture drives many resident
microbiota into a dormant state. However, in certain parts of the body (scalp,
ears, axillary areas, genitourinary and anal regions, perineum, palms), moisture
is sufficiently high to support a resident microbiota.
(2) The skin has a slightly acidic pH due to the organic acids produced by normal
staphylococci and secretions from skin oil and sweat glands. The acidic pH (4
to 6) discourages colonization by many Microorganisms.
(3) sweat contains a high concentration of sodium chloride. This makes the skin
surface hyperosmotic and osmotically stresses most microorganisms.

(4) Certain inhibitory substances (bactericidal and/or bacteriostatic) on the skin

help control colonization, overgrowth, and infection from microorganisms.

 For example, the sweat glands release lysozyme (muramidase), an enzyme that
lyses Staphylococcus epidermidis and other gram-positive bacteria by hydrolyzing
the (1→4) glycosidic bond connecting N-acetylmuramic acid and N-
acetylglucosamine in the bacterial cell wall peptidoglycan.
•Most skin bacteria are found on the superficial cells, colonizing dead cells, or
closely associated with the oil and sweat glands.
•Gram-negative bacteria generally are found in the moister (wetter) regions.
• Some dermatophytic fungi may colonize the skin and produce athlete’s foot and
ringworm..
• The most prevalent bacterium in the skin glands is the grampositive,anaerobic,
lipophilic rod Propionibacterium acnes.
•This bacterium usually is harmless; however, it has been associated with the skin
disease acne vulgaris. (commonly occurs during adolescence when the endocrine
system is very active).
•Some pathogens found on or in the skin are residents that colonize the area around
orifices.
• ex: Staphylococcus aureus . It resides in the nostrils and perianal region but
survives poorly elsewhere.
• Clostridium perfringens usually colonizes only the perineum and thighs,
especially in those who suffer from diabetes.
 NOSE AND NASOPHARYNX
• The normal microbiota of the nose is found just inside the nostrils.
• The nasopharynx, that part of the pharynx lying above the level of the soft
palate, may contain small numbers of potentially pathogenic bacteria such
as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus
influenzae.
 • Staphylococcus aureus and S.epidermidis are the predominant bacteria present
and in the same numbers as on the skin of the face.

• Diphtheroids, a large group of nonpathogenic grampositive bacteria that resemble

Corynebacterium are commonly found in both the nose and nasopharynx.
 OROPHARYNX
• The oropharynx is that division of the pharynx lying between the soft
palate and the upper edge of the epiglottis.
• Like the nose,large numbers of Staphylococcus aureus and S.epidermidis
inhabit this region.
• The most important bacteria found in the oropharynx are the various
alphahemolytic streptococci (S.oralis, S.milleri, S. gordonii, S.salivarius)
and small gram-negative cocci related to Neisseria meningitidis
 RESPIRATORY TRACT
• The upper and lower respiratory tracts (trachea,
bronchi,bronchioles,alveoli) do not have a normal microbiota.
• This is because microorganisms are removed by
(1) the continuous stream of mucus generated by the ciliated epithelial cells
(2) the phagocytic action of the alveolar macrophages.
In addition, a bactericidal effect is exerted by the enzyme lysozyme, present
in nasal mucus.
 MOUTH
• The normal microbiota of the mouth or oral cavity contains organisms
able to resist mechanical removal by adhering to surfaces like the gums
and teeth.
• Those that cannot attach are removed by the mechanical flushing of the
oral cavity contents to the stomach where they are destroyed by
hydrochloric acid.
• The continuous desquamation (shedding) of epithelial cells also removes
microorganisms.
•Those microorganisms able to colonize 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.
• The oral cavity is colonized by microorganisms from the surrounding
environment within hours after a human is born.
•Initially the microbiota consists mostly of the genera Streptococcus, Neisseria,
Actinomyces, Veillonella, and Lactobacillus. Some yeasts also are present.
•Most microorganisms that invade the oral cavity initially are aerobes and obligate
anaerobes.
• When the first teeth erupt, the anaerobes (Porphyromonas, Prevotella, and
Fusobacterium) become dominant due to the anaerobic nature of the space between
the teeth and gums.
•As the teeth grow, Streptococcus parasanguis and S. mutans attach to their enamel
surfaces; S.salivarius attaches to the buccal and gingival epithelial surfaces and
colonizes the saliva.
•The presence of these bacteria contributes to the eventual formation of dental
plaque, caries, gingivitis, and periodontal disease.
 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 Staphylococcus epidermidis followed by S.
aureus, aerobic corynebacteria (diphtheroids), and Streptococcus pneumoniae.
• Cultures from the eyelids or conjunctiva also yield Branhamella catarrhalis,
Escherichia, Klebsiella, Proteus, Enterobacter, Neisseria, and Bacillus species.
• Few anaerobic organisms are present.
 EXTERNAL EAR
• The normal microbiota of the external ear resemble those of the skin, with
coagulase-negative staphylococci and Corynebacterium predominating.
• Less frequently found are Bacillus, Micrococcus, and Neisseria species.
• Gram-negative rods such as Proteus, Escherichia, and Pseudomonas are
occasionally seen.
• Mycological studies show the following fungi to be normal microbiota:
Aspergillus,Alternaria, Penicillium, Candida, and Saccharomyces
 STOMACH
• Many microorganisms are washed from the mouth into the stomach. Owing to the
very acidic pH values (2 to 3) of the gastric contents, most microorganisms are
killed.
• As a result the stomach usually contains less than 10 viable bacteria per milliliter
of gastric fluid. These are mainly Sarcina, Streptococcus, Staphylococcus,
Lactobacillus,Peptostreptococcus, and yeasts such as Candida spp.
• Microorganisms may survive if they pass rapidly through the stomach or if the
organisms ingested with food are particularly resistant to gastric pH
(mycobacteria).
•Normally the number of micro organisms increases after a meal but quickly falls
as the acidic pH takes its toll.
• Changes in the gastric microbiota also occur if there is an increase in gastric pH
following intestinal obstruction, which permits a reflux of alkaline duodenal
secretions into the stomach.
• If the gastric pH increases, the microbiota of the stomach are likely to reflect that
of the oropharynx and, in addition,contain both gram-negative aerobic and
anaerobic bacteria.
 SMALL INTESTINE
• The small intestine is divided into three anatomical areas: the duodenum,
jejunum, and ileum.
• The duodenum (the first 25 cm of the small intestine) contains few
microorganisms because of the combined influence of the stomach’s
acidic juices and the inhibitory action of bile and pancreatic secretions.
• Of the bacteria present, gram-positive cocci and rods
• comprise most of the microbiota.
•Enterococcus faecalis, lactobacilli, diphtheroids, and the yeast- Candida albicans
are occasionally found in the jejunum.
• In the distal portion of the small intestine (ileum), the microbiota begin to take on
the characteristics of the colon microbiota.
• It is within the ileum that the pH becomes more alkaline.
• As a result anaerobic gram-negative bacteria and members of the family
Enterobacteriaceae become established.
 LARGE INTESTINE(COLON)
• The large intestine or colon has the largest microbial community in the
body.
• Microscopic counts of faeces approach 1012 organisms per gram wet
weight.
• Over 400 different species have been isolated from human faeces.
• The colon can be viewed as a large fermentation vessel, and the
microbiota consist primarily of anaerobic, gram-negative, nonsporing
bacteria and gram-positive, spore-forming, and nonsporing rods.
•Several studies have shown that the ratio of anaerobic to facultative anaerobic
bacteria is approximately 300 to 1.
• Even the most abundant of the latter, Escherichia coli, is only about 0.1% of the
total population.
• Besides the many bacteria in the large intestine, the yeast Candida albicans and
certain protozoa may occur as harmless commensals.
• Trichomonas hominis, Entamoeba hartmanni, Endolimaxnana, and Iodamoeba
butschlii are common Inhabitants.
•Various physiological processes move the microbiota through the colon so an adult
eliminates about hundreds of microorganisms daily.
• To maintain homeostasis of the microbiota, the body must continually replace
those 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
•If the intestinal environment is disturbed, the normal microbiota may change
greatly. Disruptive factors include stress, altitude changes, starvation, parasitic
organisms, diarrhoea, and use of antibiotics or probiotics.
• The actual proportions of the individual bacterial populations within the
indigenous microbiota depend largely on a person’s diet.
•With the ingestion of solid food, the initial colonizers of the colon are eventually
displaced by a typical gram-negative microbiota. Ultimately the composition of the
adult’s microbiota is established.
 GENITO URINARY TRACT
• The upper genitourinary tract (kidneys, ureters, and urinary bladder) is
usually free of microorganisms.
• In both the male and female, a few bacteria (Staphylococcus epidermidis,
Enterococcus faecalis, and Corynebacterium spp.) usually are present in
the distal portion of the urethra.
• Neisseria and some members of the Enterobacteriaceae are occasionally
found
•In contrast, the adult female genital tract, because of its large surface area and
mucous secretions, has a complex microbiota that constantly changes with the
female’s menstrual cycle.
• The major microorganisms are the acid-tolerant lactobacilli, primarily
Lactobacillus acidophilus, often called Doderlein’s bacilli.
•They ferment the glycogen produced by the vaginal epithelium, forming lactic
acid.
• As a result the pH of the vagina and cervix is maintained between 4.4 and 4.6
 Reference
• Presscott, Harley and Kleins (2008) Microbiology - New York.