MICROBIOLOGY LECTURE 4 – Microbial Flora in Health and C.

Eye colonizer
Disease - Dra. Evelina N. Lagamayo 1. coagulase-negative staphylococcus
Notes from Lecture 2. Potential pathogens
USTMED ’07 Sec C – AsM a. Hemophlius spp.
b. Neisseria spp.
Factors that determine microbial flora in and on the human c. Viridans streptococci
body:
1. Age D. Lower Respiratory Tract
2. Diet - larynx, trachea, bronchioles and lower airways are
3. Hormonal state generally sterile
4. Health 1. acute lower airway disease:
5. Sanitary conditions a. Strep. Pneumoniae
6. Personal hygiene b. Staph. Aureus
c. H. influenza
Two important points to be emphasized: d. Members of Enterobacteriaceae (Klebsiella
- care should be taken to maintain the normal balance of spp.)
microbes 2. chronic aspiration
- An important distinction exists between colonization o polymicrobial disease
with pathogenic organism and disease a. anaerobes (Peptostreptococci)
b. and anaerobic gram negative bacilli
How does Normal Microbial flora control the proliferation of c. Candida spp. demonstrated in tissue
Pathogenic organisms? d. Dimorphic fungi (Histoplasma, Coccidioides,
- competition for nutrients or receptors on host cells Blastomyces spp.)
- production of bacteriocins (small-molecular-weight
proteins that are bactericidal for other organisms) E. Gastrointestinal Tract
- Stimulation of immune response 1. stomach
a. lactic acid-producing bacteria
Normal flora is Pathogenic organisms b. Lactobacilli
disrupted (e.g. by are introduced into a c. Streptococci
broad-specturm normally sterile
d. Helicobacter pylori
antibiotics environment
o affected by drugs that neutralize or reduce
production of gastric acid
2. Small intestines
o bacteria, fungi and parasites
o Common casues of gastroenteritis
DISEASE IS PRODUCED  Salmonella spp
 Campylobacter spp.
Example: 3. Large intestines
Oro-pharyngeal flora Aspiration of oral a. Anaerobes:
secretions into the lower  avirulent bifidobacteria
Streptococcus respiratory tract  eubacteria
pneumoniae  Peptostreptococci
Staphylococcus aureus
Gram-negative bacilli  Bacteroides fragilis group
b. Facultative anaerobes
 Enterobacteriaceae
Bronchopulmonary disease
 Enterococci
c. Antibiotic-resistant organisms
Classes of Microbes according to their propensity for causing  Enterococci
disease:  Pseudomonas
1. Opportunistic pathogens – will not cause disease except  Fungi
in immunocompromised patients  Clostridium difficile-diarrhea to
o example: Staphylococcus epidermidis at the pseudomembranous colitis
site of IV catheter d. Enteric pathogens:
2. Strict pathogens – always associated with disease  Shigella
o example: Mycobacterium tuberculosis, Shigella  Enterohemorrhagic E. coli (EHEC)
spp., Neisseria gonorrhea  Entamoeba histolytica
3. Facultative pathogens – associated with disease;
majority of organisms F. Genitourinary System
o Example: Staphylococcus aureus, Escherichia 1. Anterior urethra
coli, Candida albicans a. avirulent organisms:
 lactobacilli
Respiratory Tract and Head
 corynebeacterium
A. Colonizers of the upper respiratory tract:  coagulase negative staphylococci
1. Anaerobic bacteria b. colonizers that can lead to disease:
a. Peptostreptococcus  enterococci
b. Fusobacterium  Enterobacteriaceaaae
c. Prophyromonas
 Candida
d. Bacteroides
c. Asymptomatic colonizers:
e. Actinomyces
2. Aerobic organisms:  Neisseria gonorrhea
a. Viridans group streptococci  Chlamydia trachomatis
b. Coagulase-negative staphylococci d. Significant irregardless of the presence or
c. Nonpathogenic Neisseria absence of symptoms
d. Haemophiluss spp (not H. influenza) 2. Vagina
3. Potentially pathogenic organisms a. Newborn girls
a. Group A streptococci  Lactobacilli from birth up to 6 weeks
b. Streptococcus pneumoniae  Staphylococcus
c. Staphylococcus aureus  Streptococcus
d. Neisseria meningitides  Enterobacteriaceae
e. Hemophilus influenza b. Puberty
f. Moraxella catarrhalis  Lactobacilli
g. Enterobacteriaceae  Staph aureus
B. Ear colonizer  Coagulase negative staph
1. Coagulase negative staphylococcus  Streptococcus (group B)
2. Potential pathogens  Enterococci
a. Streptococcus pneumonia
 Gardnerella vaginilis
b. Pseudomonas aeruginosa
 Mycoplasma/Ureaplasma
c. Enterobacteriaceae
  Esterobactenaceae
 Anaerobes

o important cause of Vaginitis

Infections most commonly associated with immune deficiencies
1) Mobiluncus and Gardnerella
2) Mycoplasma hominis Defect Predisposing Condition Infection
3) Trichomonas vaginalis Phagocytic Acute leukemia Staphy aureus
4) Candida albicans abnormalities Cytotoxic drugs S. epidermidis
5) Torulopsis glabrata Radiation therapy Pseudomonas
c. Causes of persistent infection of GUT: Corticosteroid therapy aeruginosa
diabetes Enterobacteriaccea
 Herpes simplex virus
Candida
 Papillomavirus
Aspergillus
G. Skin
Zygomycetes
o coagulase negative staphylococci
Splenectomy Bacterium with strep.
o Staphylococcus aureus, less common
Pneumoniae
o Clostridium perfringens, approx 20% of healthy Hemophilus
individuals influenzae
o Candida and Malassezia, moist sites Complement Genetic disorders Bacteremias and
o Streptococci, transient only (toxic volatile abnormalities C3 deficiency pneumonias with
fatty acids produced by propionibacteria C5-C9 deficiency encapsulated
organisms
Nosocomial Infections Disseminated
Definition: Neisseria infections
- hospital acquired infection transmitted to patients by Antibody Hypogammaglobulinemia Encapsulated and
hospital personnel and other patients, or may arise from deficiency Multiple myeloma extracellular bacteria
the patient’s own endogenous flora Lypnocytic leukemia Enterovirus
Lymphomas Giardia
- Modes of acquisition of Nosocomial Infections Nephrotic syndrome
1. Surgical procedures Steroids or cytotoxic
2. Indwelling intravenous or bladder catheters drug therapy
3. Endotracheal tubes Cell- Hodgkin’s disease, Systemic infection
4. Intravenous fluids mediated steroid therapy, with Mycobacterium
5. Equipment used for respiratory support immunity Cytotoxic drug therapy and other intracellular
disfunction Uremia bacteria, Candida and
- Incidence of Nosocomial Infections Maltnutrition, AIDS systemic fungi, DNA
o 80%> of nosocomial infections involve: viruses, protozoa,
a. urinary tract Pneumocystis,
b. respiratory tract Strongyloides
c. surgical wounds

- Nosocomial Infections in Acute Care Institutions

-fin-
Infection % of All Most common agents
Site Nosocomial
Infection audsmartinez@gmail.com
Urinary tract 40% E. coli, enterococcus, Proteus, ustmedc3@yahoogroups.com
Klebsiella, Pseudomonas,
aeruginosa
Surgical 20% Staph aureus, Staph epidermidis,
wounds E. coli
Pulmonary 10% Klebsiella, Pseudomonas, E. coli,
Staph aureus
Primary 5-10% Staph aureus, S. epidermidis, GNB
bacteremia
Others 20-25% Staph aureus, E. coli

Opportunistic Infections
Definition:
- Infections that occur as a result of abnormalities in host
defense
- May occur as a complication of abnormal defense
mechanisms or as a result of various iatrogenic or
nosocomial factors