Normal Flora of the Body

Dr. A. A. Wegdan

Important Definitions
Conventional Pathogens: Responsible for causing disease in healthy individuals and account for only a small percent of total microbial population. Conditional Pathogens: Responsible for causing disease only in persons with reduced immunity, or when implanted directly into tissues, or in a normally sterile body area. Opportunistic Pathogens: Responsible for causing generalized disease but only in patients with profoundly diminished resistance to infection.

Important Definitions
Virulence of an Organism: Is a measure of the ability of an organism to cause disease and transmit it from one person to another. Infectious or Contagious Diseases: These diseases are caused by pathogens which have the ability to be transmitted very easily from person to person. Infection: The organisms had entered a site, had colonized and caused pathological and immunological reactions with or without clinical signs.

Important Definitions
Colonization: It is the presence of a potential pathogen that can cause infection at any time. In fact, those who progress from colonization to infection represent only the "tip of the iceberg" of persons carrying a particular pathogen. Carrier: Is a healthy person with a pathogen, not showing signs and symptoms of disease, but is a source of infection to others. May be a temporary state or may continue indefinitely.

Important Definitions
Normal flora: These are a wide variety of micro - organisms densely populating some surfaces and areas of the body (skin and mucous membranes) of healthy normal persons. Commensals: Not harmful, prevent harmful organisms from causing infection, and may be responsible for many hospital acquired infections.

Normal Flora Of The Body

The skin and mucous membranes always harbor a variety of microorganisms that can be arranged into two groups: Resident flora: It consists of a fixed types of microorganisms regularly found in a given area at a given age. If disturbed, it promptly re-establishes itself. Transient flora: It consists of nonpathogenic or potentially pathogenic microorganisms that inhabit the skin or mucous membranes for hours, days or weeks. They are easily removed mechanically by washing, by natural body fluids or by use of disinfectants.

Role of Normal flora

Resident flora of certain areas plays a definite role in maintaining health and normal function, e.g. resident flora of the intestine synthesize vitamin K, niacin, thiamin and aid in the absorption of nutrients. On mucous membranes and skin, the resident flora may prevent colonization by pathogens through bacterial interference.

Role of Normal flora

Members of the normal flora may themselves produce disease under certain conditions: 1. If introduced into the blood stream, e.g. viridans streptococci. 2. If they change their natural site, e.g. E. coil, in urinary tract infection. 3. In immuno-compromised individuals.

Normal Flora of the Skin

Staph. aureus colonizes the nose and perineum. Staph. epidermidis and micrococci. Aerobic and anaerobic diphtheroids. Non-pathogenic Neisseria species. Alpha hemolytic and nonhemolytic streptococci. Saprophytic mycobacteria, e.g. M. smegmatis. Small numbers of other organisms, e.g. Candida species in skin folds.

Normal flora of the Mouth and Upper Respiratory Tract

Alpha hemolytic streptococci e.g. Strept.

mutans, Strept. salivarius, Neisseriae, S. epidermidis. Anerobic organisms e.g. Bacteroides melaninogenicus, Fusobacterium species, anaerobic spirochetes.
N.B: Sinuses, trachea, bronchi and lungs are normally sterile.

Normal Flora of the Gastrointestinal Tract

At birth, the intestine is sterile but organisms are soon introduced with food. In the normal adult, stomach and upper part of small intestine are sterile due to stomach acidity and intestinal enzymes. Large number of flora are found in the terminal ileum.

Normal Flora of the Gastrointestinal Tract

The colon contains large number of fecal flora. These are anaerobes (96-99% of resident flora), e.g. Bacteroides fragilis, Cl. perfringens and anaerobic streptococci. Only 1-4% are facultative anaerobes e.g. E. coil, Ent. fecalis, Proteus species, Pseduomonas species, Lactobacilli and Candida.

Normal Flora of the Vagina

Soon after birth, pH of the vagina is acidic under influence of maternal estrogen (several weeks), so lactobacilli appear in the vagina. Before puberty, pH becomes neutral or alkaline, and there are mixed flora e.g. S. epidermidis, anaerobic streptococci. At puberty and till menopause, lactobacilli reappear and contribute to the maintenance of acidic pH.