HUMAN AND MICROBIAL

INTERACTIONS
 I. NORMAL OR INDIGENOUS
FLORA
 A. DEFINITION
 NORMAL FLORA (Indigenous flora)

-- microorganisms that are frequently found

in particular sites of the body in normal
healthy individuals
 HOST – living organism that harbors
another living organism
 PATHOGEN – a microorganism that causes
disease.
 B.CATEGORIES OF NORMAL FLORA
1. Symbionts (Mutualism)
-- the microbe and the host are of benefit to
one another
-- ex. Normal flora of the large intestine
2. Commensals (Commensalism)
--neutral relationship to the host
-- microbe receives benefit from the host
but host receives no harm/benefit from
the microbe
a. Resident Flora– most of the flora of the
body; present invariably or for
weeks/months in a particular
environment
 b. Transient Flora
-- Non-pathogenic or potentially
pathogenic microorganisms that establishes
themselves briefly for colonization or
infection without disease
Ex. Neisseria

3. Opportunists
-- potential pathogens
-- lack the ability to invade and cause
disease in healthy individuals
 C. CONDITIONS THAT DETERMINE THE
NATURE OF THE FLORA
1. Local Physiologic and Ecologic conditions
a. amounts and types of nutrients available
b. pH
c. oxidation-reduction potentials
d. resistance to local antimicrobial substance
e. temperature
f. moisture
2. Various microbial interactions
a. competition for nutrients
b. inhibition by metabolic products of other
organisms
3. Bacterial adherence
--presence of pili or fimbriae
 D. ORIGIN OF NORMAL FLORA

1. Healthy fetus
-- sterile until birth membrane ruptures

2. During and after birth

-- flora of mother’s genital tract
-- skin and respiratory tract
-- environment
 E. NORMALLY STERILE IN BODY
(NO FLORA)
1. Blood
2. Body Fluids
--- CSF, urine
3. Tissues
--- urinary bladder, uterus, fallopian tubes,
middle and inner ear, paranasal sinuses
 F. NORMAL FLORA OF THE DIFFERENT
SITES
1. Skin
- flora are most abundant in moist areas
- aerobic and anaerobic diptheroids
Ex. Corynebacterium
- non-hemolytic aerobic and anaerobic staphylococci
- alpha hemolytic streptococci, Enterococci
- Gram(-) coliform bacilli and acinetobacter
- Fungi and yeast

Factors that eliminate non-resident MO from the skin

a. fatty acids in sebaceous secretions
b. presence of lysozyme
2. Respiratory tract
a. Upper respiratory tract (Nasopharynx)
-- same as oral organisms
-- transient carriage of: S. pneumonia,
Hemophilus
b. Lower respiratory tract
--usually free of microbes
3. Eyes: Conjunctival Sac
-- very scanty, usually non-pathogenic bacteria
-- contain lysozyme
-- organisms: Corynebacterium, Moraxella,
Staphylococcus epidermis, non-hemolytic
streptococcus
4. Digestive Tract
a. Mouth — tongue and buccal mucosa
-- Strep viridans, Neisseria sp, Branhamella,
occasionally Candida albicans
-- Gingival crevices and tonsillar crypts
-- anaerobic flora, Bacteroides, Treponemes,
Clostridia
b. Esophagus — transient mouth flora
c. Stomach – rapidly becomes sterile after meals
d. Small intestine – scanty resident flora except in
the lower ileum. Ex. Streptococcus, lactobacilli,
Yeast (candida)
e. Colon – largest number of microbes
(400 species)
-- anaerobes: 96-99%
-- Bacteroides, anaerobic Lactobacilli,
Clostridium
-- Facultative: 1-4%, E. coli, Proteus
Pseudomonas, Candida
-- Breastfed babies: 99% anaerobic —
Bifidobacterium
--Artificially fed babies — Lactobacillus
acidophilus
5. Genito-urinary tract: urinary tract
— sterile above the distal 1 cm of
the urethra
-- vagina – before puberty and post
menopausal stage
-- derived from flora of skin and colon
-- child bearing age
-- Lactobacilli, aciduric strep., yeast
G. BENEFICIAL EFFECTS OF NORMAL FLORA
1. Production of essential nutrients
-- Intestinal flora - synthesize Vitamin K &
Vit. B complex
2. Defense against microbial pathogens
a. Bifidobacteria and breastfeeding
-- inhibit colonization of enteric pathogens
b. Vaginal flora (Lactobacillus)
-- provides protection vs gonococcal
vulvovaginitis
c. Prolonged antibiotic treatment alter GIT
-- Candida diarrhea
-- S. aureus necrotizing enterocolitis
-- C. difficile pseudomembranous colitis
 H. HARMFUL EFFECTS: OPPORTUNISTIC
INFECTION
-- Local or generalized host defense mechanisms
are compromised
-- flora reaches protected areas of body in sufficient
numbers
-- E. coli ascend urethra UTI
-- Colon perforation feces in peritoneal cavity
(peritonitis)
-- Viridians strep bacteremia + physiologic
trauma or injury colonize previously
damaged valves bacterial endocarditis
 II. MICROBES VS HUMANS
A. DEFINITION
SYMPTOMS
-- evidence of disease that is experienced or
perceived
-- subjective changes in body function noted
by patient but not apparent to an observer
SIGNS
-- objective evidence of a disease the
physician/nurse can observe and measure
SYNDROME
-- a specific group of signs and symptoms
that accompany a particular disease.
INCIDENCE
-- number of people in a population who
develop a disease during a particular time
period.

PREVALENCE
-- the number of people in a population who
develop a disease regardless of when it
appeared
-- both old and new cases
 B. CLASSIFICATION OF INFECTIOUS
DISEASES
BASED ON BEHAVIOR WITHIN THE HOST:
1. Communicable Disease
-- any disease that spreads from one host to
another either directly or indirectly
-- contagious disease disease that
easily spreads from one person to another.

2. Non-communicable disease
-- not spread from one host/person to another
 BASED ON OCCURRENCE OF DISEASE
1. Sporadic disease
-- disease occurs only occassionally
ex. Botulism, tetanus
4. Endemic disease
-- constantly present in a population,
community or country. Ex. TB
6. Epidemic disease
-- acquire disease in a relatively short period
-- greater than normal number of cases in an
area within a short period of time.
9. Pandemic disease
-- epidemic disease that occurs worldwide
Ex. HIV
 BASED ON SEVERITY OR DURATION OF
DISEASE
1. Acute disease
-- develops rapidly (rapid onset) lasts only a short time
Ex. Measles, mumps, influenza

• Chronic disease – develops slowly (insidious onset)

-- disease is likely to be continual or recurrent for long
periods Ex. TB, leprosy

• Subacute disease– intermediate between acute and

chronic. Ex. Bacterial endocarditis

• Latent disease - causative agent remains inactive for a

time but then becomes active to produce symptoms
of the disease. Ex. Chickenpox  Shingles (Zoster)
BASED ON EXTENT OF AFFECTED HOST’S
BODY
• Local infection
-- microbes invade a relatively small area of
the body.

• Generalized (Systemic) Infection

-- spread throughout the body by blood or
lymph ex. measles

• Focal Infection
-- local infection that spread but are
confined to specific areas of the body.
 BASED ON STATE OF HOST RESISTANCE

1. Primary Infection
-- acute infection that causes the initial illness

• Secondary infection
-- one caused by an opportunistic pathogen
after the primary infection has weakened the
body’s defenses.

• Subclinical (Inapparent) Infection

-- does not cause any noticeable illness.
 C. FACTORS IN DISEASE DEVELOPMENT
(CHAIN OF INFECTION)

2. Source of Infection (the pathogen)

3. Reservoir
4. Portal of exit
5. Mode of transmission
5. Portal of entry
6. Susceptible host
FACTORS PERTAINING TO PATHOGEN:
C. Virulence of pathogen
D. Portal of entry
E. # of organisms that enter the body

FACTORS PERTAINING TO HOST:

• Health status
• Nutritional status
• Age, lifestyle, SE level, travel, hygiene, subs.
abuse & immune status
 D. STAGES OF DISEASE
• Incubation Period --time interval between initial
infection and 1st appearance of any s/sx
2. Prodromal period — early, mild symptoms of disease
• Period of illness --- overt s/sx of disease
--- WBC may increase or decrease
--- result to death if immune responses and/or
medical treatment fails
• Period of decline
—s/sx subside
--- vulnerable to secondary infection
11. Period of convalescence
--- regains strength and body returns to
pre-diseased state
--- recovery has occurred
 III. THE SOURCE OF INFECTION
(THE PATHOGEN)
B. DEFINITION
PATHOGENECITY
- capability of a pathogen to cause disease
- factors: 1. Ability to infect host
2. Protect from body’s defenses
3. Invade and multiply in tissues
4. Cause damage or destruction to
tissues
VIRULENCE
- Measure or degree of pathogenecity
B. VIRULENCE FACTORS
1. Bacterial Structures
a. Flagella - enable bacteria to invade
aqueous areas of the body.
b. Capsules - enable bacteria to attach to
tissues
-- anti-phagocytic function
-- ex. Strep. Pneumoniae
c. Pili (Fimbriae)
-- enable bacteria to adhere to tissues
-- ex. E. coli, V. cholerae, Neisseria
2. Enzymes (Exoenzymes)
a. Coagulase– ex. S. aureus
--clots plasma forms fibrin clot protection
from phagocytosis
b. Kinases (Fibrinolysins)
--lyse /dissolve clots & allows spread of organism
c. Hyaluronidase (the spreading factor)
--allows bacteria to spread through tissues by breaking
down hyaluronic acid (“cement”)
--ex. Staphylococcus, streptococcus, clostridium
d. Collagenase– ex. Clostridium perfringens
--breaks down collagen in skin, tendons, cartilage and
bones
e. Hemolysins—cause damage(lysis) to host’s RBC
--important in identification of organism (alpha or beta
hemolytic)
f. Lecithinase—ex. Clostridium perfringens
--breaks down phospholipids (lecithin) found in
membranes of RBC and other tissues.
3. Toxins (Poisonous Substances)
a. Endotoxin: Lipopolysaccharide (LPS)
--part of outer portion of cell wall of gram (-)
bacteria
--can cause pyrogenic response
-- ex. Typhoid fever, UTI, meningitis
b. Exotoxins
--produced inside mostly Gram (+) bacteria
--proteins
--ex. Diphtheria toxin, botulinum toxin, tetanus
toxin
--leukocidin toxins that destroy WBC
--neurotoxin toxins that affect CNS
(botulinum toxin)
-- enterotoxins toxins that affect GIT ex. E.coli,
V. cholerae)
 IV. EPIDEMIOLOGY AND DISEASE TRANSMISSION
A. RESERVOIRS OF INFECTIONS
--any site where the pathogen can multiply or merely survive until it is
transferred to the host.
1. Human Reservoir
- principal living reservoir of human disease
a. direct transmission
--with signs and symptoms of disease and transmit the disease
b. carriers—harbor the pathogens but have no s/sx
b.1 incubatory carriers--capable of transmitting a pathogen
during the incubation period
b.2 convalescent carriers—transmit disease during
convalescence or recovery period.
b.3 active carriers– completely recovered from disease but
continue to harbor the pathogen indefinitely
b.4 passive carriers– carry the pathogen without ever having
the disease.
2. Animal Reservoir
ZOONOSES infectious diseases that humans
acquire from animal sources
--150 zoonoses

Routes:
a. direct contact—with infected animal or with
domestic pet waste
b. Inhalation– from contaminated hides, fur,
feathers
c. Ingestion– contaminated food and water
-- consumption of infected animal products
d. Injection of the pathogen
--insect vectors
3. Inanimate (Non-Living) Reservoirs
--air, soil, food, milk, water, fomites

FOMITES
--articles that are easily contaminated by
pathogens from the respiratory tract, intestinal
tract and skin

AIR
--droplets of respiratory tract secretions
--dust particles
 B. MODE OF DISEASE TRANSMISSION

1 Contact transmission
-- spread of an agent of disease by direct, indirect
or droplet transmission
b. Direct Contact Transmission
--person to person transmission of an agent by
physical contact between its source and
susceptible host
--no intermediate object involved
--touching, kissing, sexual intercourse
--SOURCE : SUSCEPTIBLE HOST
B. MODE OF DISEASE TRANSMISSION
b. Indirect Contact Transmission
--reservoir to a susceptible host by means of a
non-living object (fomites)
--source : non-living object, susceptible host

c. Droplet Transmission
--microbes spread in droplet nuclei that travel
only short distances (<1 meter)
-- ex. Coughing, sneezing, laughing or talking
2. Vehicle Transmission
--transmission of disease agents by a medium. Ex. H20,
food, air, blood and other body fluids, drugs and IV fluids)
a. Waterborne transmission
-- H20 contaminated with untreated or poorly treated
sewage ex. Cholera, Shigella
b. Foodborne transmission
-- transmitted by foods that are incompletely cooked,
poorly refrigerated or prepared under unsanitary
conditions. Ex. Food poisoning, tapeworm infection
c. Airborne transmission--spread of agents of infection by
droplet nuclei in dust that travel. < 1 meter
3. Vectors—animals that carry pathogens from one host to
another
 C. CONTROL OF EPIDEMIC DISEASE

2. Report cases of communicable diseases to

proper agencies
3. Public education
4. Identification and eliminated reservoirs of
infection
5. Isolate diseased persons
6. Participate in immunizing programs
7. Help to treat sick persons