NORMAL FLORA OF THE HUMAN BODY

DEFINITION:
Various bacteria and fungi are permanent residents of certain body
sites, e.g.: skin, oropharynx, colon and vagina. Viruses and parasites are
not considered part of normal flora .Free sites of the body are: CNS,
blood, lower bronchi, alveoli, liver, spleen, kidneys, and bladder.

CARRIER STATE:
This is different from normal flora. A carrier is an individual
harbouring a potential pathogen, hence he is a source of infection.
Colonization by an organism occurs when the organism establishes itself
for a long time in an individual.

ROLE IN HEALTH AND DISEASE:

1.May cause disease in immunosuppressed and debilitated
individuals. Here normal flora although not pathogenic in their
usual site, they become pathogenic in other parts of the body. .
2.May form a protective host defence mechanism. Normal flora
prevent pathogens to multiply easily, hence they act as defence
against infection.
3.May serve as a nutritional function. Flora of the intestine produce
VIT. B &VIT. K, that are needed for nutrition. Oral antibiotics
given for a long time shall destroy normal flora of the intestine.

NORMAL FLORA OF SKIN:

Mainly Staph. epidermidis which become pathogenic when it reaches an
artificial heart valve. Peptococcus and Propionibacterium are situated
in the deeper follicles in the dermis, because they are anaerobic.

NORMAL FLORA OF THE RESPIRATORY TRACT:

Most flora inhabit nose, throat, and mouth. Lower bronchi and alveoli
are almost sterile.
Nose: Colonized by streptococci and mainly Staph. aureus.
Throat: Colonized by Strept. viridans, Neisseria, Staph. epidermidis.
This flora inhibit the growth of pathogens, e.g.: N. meningitidis,
S. aureus, and Strep. Pyogenes.
Mouth: Colonized mainly by Strep. viridans, e.g.: Strep. mutans that is
associated with dental plaque and caries. Strep. viridans also may lead
to subacute bacterial endocarditis, by entering the blood during dental
surgery and attach to damaged heart valves. Eikenella corrodens
(normal flora of mouth) may cause skin and soft tissue infections
associated with human bites and injuries due to fist fights. Gums and
gingiva are colonized by anaerobic organisms, e.g:: Bacteroides,
Clostridium, Fusobacteria, and Peptostreptococcus. In patients with
poor dental hygiene, these organisms may be aspirated and lead to lung
abscess. Actinomyces israeli inhabiting the gingiva may also lead to
abscesses of jaw, lungs and abdomen.

NORMAL FLORA OF INTESTINAL TRACT:

Stomach: With enzymes and low pH, hence very few organisms.
Small Intestine: Small numbers of Strep., lactobacilli and Candida
albicans.
Colon: Major site of flora.
Significance: Plays role in extra intestinal infection, e.g. E.coli leads to
UTI. Bacteroides lead to peritonitis associated with appendicitis,
perforation of intestine, and diverticulitis. Strep faecal leads to UTI and
endocarditis. Pseudomonas aeruginosa leads to UTI, wound infections,
etc. Clindamycin and other antibiotic therapy will suppress colon flora
and allows Clost. difficile to overgrow and produces its toxin to give
severe colitis.

NORMAL FLORA OF THE GENITOURINARY TRACT:

Lactobacillus colonizes the vagina. Before puberty and after
menopause, oestrogen level is low, lactobacilli are few, vaginal pH is
high (alkaline). After puberty, oestrogen level high, lactobacilli multiply
to make vagina acidic, and suppress vaginal pathogens.
Vagina being close to anus, may be contaminated by faecal flora, e.g
E.coli and Enterobacter, leading to recurrent UTI. 15 - 20 % of women
harbour group B Strept. in vagina, and this leads to sepsis and
meningitis of the newborn while passing through the birth canal.
Urine in bladder is sterile, becomes contaminated while passing through
urethra by S. epidermidis, coliforms, diphtheroids. non-haemolytic
Strept, and Myco. smegmatis.
NORMAL FLORA OF CONJUNCTIVA:
Mainly diphtheroids, Neisseria, Haemophilus, Moraxella,
S. epidermidis, non-haemolytic streptococci. .

CLASSIFICATION:
•Resident flora
•Transient flora: May be pathogenic or non-pathogenic. May live
for hours, days or weeks on skin and mucous membranes.
They are eliminated by:
a. Low pH of skin
b. Fatty acids in sebaceous glands of skin.
c. Lysozyme on skin
Washing, bathing and sweating will not remove transient skin flora,
only scrubbing can do that.

ADVANTAGES OF INTESTINAL FLORA:

•Synthesis of VIT. K and VIT. B
•Conversion of bile pigment to bile acids
•Absorption of nutrients and breakdown of products.
•Antagonism of pathogenic bacteria

LOCATIONS OF NORMAL FLORA:

1.Bacteroides: colon, throat, vagina
2.C. albicans: mouth colon, vagina
3.Clostridium: colon
4.Diphtheroids: nasopharynx, skin, vagina
5.E. coli + coliforms : colon, vagina, outer urethra
6.Gardnerella vaginalis: vagina
7.Haemophilus: nasopharynx, conjunctiva
8.Lactobacillus: mouth, colon, vagina
9.NeNisseria : mouth, nasopharynx
10. Ps. aeruginosa : colon, skin
11. S. aureus : skin, nose
12. S. epidermidis : skin, nose, mouth, vagina, urethra.
13. E. faecalis : colon
14. S. viridans : mouth, nasopharynx.
 NORMAL FLORA OF MEDICAL IMPORTANCE

Location Important organism

Skin S. epidermidis
Nose S. aureus
Mouth Strep.viridans
Dental plaque S. mutans
Bacteroides, Fusobacterium, Anaerobic
Gingiva
cocci, Actinomyces
Throat S. viridans
Colon Bacteroides fragilis, E. coli
Vagina
Lactobacillus, E. coli, group B Strept.
Urethra S. epidermidis, diphtheroids, E. coli

MAJOR BACTERIA IN COLON

Bacterium Pathogen
Bacteroides fragilis Yes
Bifidobacterium No
Eubactrium No
Coliforms Yes
Enterococcus faecalis Yes
Lactobacillus No
Clostridium perfringens Yes