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microbiology

Lecturer: dr. adelina talavera


Topic: normal human biota

Definition  is derived from the environment


 does not produce disease
Normal flora  does not establish itself permanently on
 the mixture of microorganisms ( bacteria and the surface
fungi ) that are regularly found at any
Commensals
anatomical site of the human body.
 microorganisms that are constantly
 denotes the population of microorganisms that
inhabit the skin and mucous membranes of present on body surface. Their
healthy normal persons. presence depends upon
Microbiome  physiologic factors of temperature and
 genome of these microbial symbionts moisture
 presence of certain nutrients
ADVANTAGE OR IMPORTANCE OF THE  presence of inhibitory substances
NORMAL FLORA Bacterial interference
1. normal flora constitute a protective host defense  when resident microbiota on mucous
mechanism by occupying ecological niches. membrane and skin may prevent
2. normal flora produce vitamin B and vitamin K in colonization of pathogens and possible
the intestines. disease. Mechanism may involved the
3. normal flora may antagonize other bacteria following :
through the production of substances which 1. competition of receptors or binding sites
inhibits or kill non-endogenous species on host cells
4. normal flora play a role in toxin degradation 2. competition for nutrients
5. normal flora contribute to maturation of the 3. mutual inhibition by metabolic or toxic
immune system products
4. mutual inhibition by antibiotic materials
DISADVANTAGE OF THE NORMAL FLORA
1. Normal flora cause disease in the following Sterile Tissues
 when an individual become  In normal healthy human, the
immunocompromised or debilitated internal tissues such as the
 when they change their usual anatomic brain, Blood, muscle and CSF
location  These are normally free of
 when they are introduced to foreign microorganisms
locations in large numbers
 when predisposing factors are present NORMAL MICROBIOTA OF THE SKIN
2. Oral flora of humans may harm their host
since some of these bacteria are Skin is the human body’s largest organ, colonized
pathogens or opportunistic pathogens. by a diverse array of microorganisms, most of
 Example : during tooth extraction; which are harmless and beneficial to the host.
streptococcus viridans are the most
resident flora of URT. The predominant resident microorganisms of the
Bloodstream→→settle on deformed or skin
prosthetic valves→→infective endocarditis.  aerobe and anaerobic diphtheroid
bacilli( corynebacterrium;
ROLE OF RESIDENT MICROBIOTA propionebacterium
• Two groups in which the skin and mucous  nonhemolytic aerobic and anaerobic
membranes harboring variety of staphylococci ( staph epidermidis;
microorganisms can be arranged as : peptostreptococcus )
1. the resident microbiota consists of  gram positive, aerobic, spore forming
relatively fixed types of microorganisms bacilli that are ubiquitous in air, water and
regularly found in given area at a given age soil
2. the transient microbiota consists of  alpha hemoplytic streptococci ( viridans
nonpathogenic or potentially pathogenic strep ) and enterococci
microorganisms that inhabit the skin or  gram negative coliform bacteria and
mucous membranes for hours, days or weeks. acinetobacter,
 fungi and yeast
 acid-fast, nonpathogenic mycobacteria
Transient Microbiota occur in areas rich in sebaceous secretions.
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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

 when it begin to erupt, anaerobic


Factors that may be important in eliminating spirochetes, prevotella spp ( P.
nonresident flora of the skin melaninogenica ), fusobacterium sp.,rothia
 low pH sp, capnocytophaga sp, also with some
 FA in sebaceous secretions anaerobic vibrios and lactobacilli.
 presence of lysozyme Tonsillar tissue and gingivae
Neither profuse sweating nor washing and bathing  Actinomyces species are normally present
can eliminate or significantly modify the normal Small bronchi and alveoli are normally sterile.
resident flora. Predominant organisms in the URT, particularly,
The number of superficial microorganisms maybe the pharynx are non hemolytic and alpha
diminished by vigorous daily scrubbing with soap hemolytic streptococci and neisseriae
( hexachlorophene ).
Infections 0f the mouth and respiratory tract
Effect of the placement of occlusive dressing on  usually caused by mixed oronasal flora,
the skin including anaerobes.
 result in a large increase in the total Peridontal infections, perioral abscesses,
microbial population sinusitis and mastoiditis
 may produce qualitative alteration in the  predominantly P melanogenica,
flora Fusobacterium, Peptostreptococcus.
Gangrene, necrotizing fasciitis, and cellulitis of skin Aspiration of saliva ( 10 to the 2 of these organisms
and soft tissues are the result of aerobic and and aerobes )
anaerobic bacteria forming synergistic process.  may result in necrotizing pneumonia, lung
The skin acts as a physical barrier but also as an abscess and empyema.
immunologic barrier. The lower respiratory tract ( trachea, bronchi,
pulmonary tissues ) are usually sterile.
Presence of keratinocytes colonizing the skin
surface through pattern recognition receptors THE ROLE OF THE NORMAL MOUTH
( TLRs –toll-like receptors; NLRs-NOD-like MICROBIOTA IN DENTAL PLAQUE AND CARIES
receptors; mannose receptors )
 initiates the innate immune response Dental plaque
 results in secretion of antimicrobial  is a complex biofilm is define as an
peptides , cytokines, chemokines adherent dental deposit that forms on the
 the skin can distinguish between harmless tooth surface composed of entirely of
commensals and harmful pathogenic bacteria from the normal flora of the
microorganism. mouth
 most prevalent and densest of human
NORMAL MICROBIOTA OF THE MOUTH biofilm
AND URT
Advantage for the microbes in the biofilm
Flora of the nose 1. protection from environmental hazards
 consists of prominent corynebacteria, ( antimicrobials )
staphylococci and streptococci. 2. optimization of spatial arrangement that
Mucous membranes of the mouth and pharynx maximize energy through movements of
 often sterile at birth but may be nutrients
contaminated by passage through the Caries
birth canal  disintegration of the teeth beginning at
Within 4 – 12 hours after birth, viridans surface and progressing inwards
streptococci established as the most prominent Streptococcus mutans
members of the resident flora and remain so for  considered to be the dominant organism
life. for the initiation of caries
Early in life, aerobic and anaerobic staphylococci, Multiple members of the plaque biofilm participate
gram negative diplococci ( Neisseriae, Moraxella in the evolution of the lesion including other
catarrhalis ), diphtheroids and lactobacilli. streptococci ( S salivarius, S sanguis, S sobrinus ),
lactobacilli ( L acidophilus, L casei ) and
Teeth actinomyces ( A viscosis, A naeslundii ).

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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

 The stomach’s acidity keeps the number of


ROLE OF NORMAL MICROBIOTA IN DENTAL microorganisms at a minimum ( 102 –
PLAQUE 103/ml of contents.
Capnocytophaga species ( gram negative,  Obstruction at the pylorus favors the
fusiform or filamentous bbacilli, gliding proliferation of gram positive cocci and
anaerobes ) Rothia species ( pleomorphic, bacilli
aerobic gram positive rods )  The normal acid pH of the stomach
 Complex microbial flora that participate in protects against infection with some
periodontal disease with prominent bone enteric pathogens ( eg. Vibrio cholera )
destruction
 they can lead to serious opportunistic Factors that would lead to a great increase of
lesions in other organs of granulocytopenic microbial flora in the stomach to prevent
immunodeficient patients peptic ulcer disease and esophageal reflux
disease
Control of caries  administration of antacids
 physical removal of plaque  H2 receptor antagonist
 limitation of sucrose intake  proton pump inhibitors
 good nutrition with adequate protein Adult duodenum – 102– 104 bacteria/ml of effluent
intake Jejunum – 104 – 105 bacteria/ml
 reduction of acid production in the mouth Ileum – 108 bacteria/ml
by limitation of carbohydrate Cecum and transverse colon – 1011 bacteria/ml
 frequent cleansing

NORMAL MICROBIOTA OF THE INTESTINAL


Microbiota of the upper intestine
TRACT
1. Mucosa
Human flora are influenced by
 bacteroides, clostridia, enterobacteriales
 age ,diet,cultural conditions and use of
and enterococci
antibiotics
2. Sigmoid colon and rectum
At birth
 bacteria constitute 60% of the fecal mass
 the entire intestinal is sterile, but
( anaerobes outnumber facultative
bacteria enter with first feed
organisms by 1000 folds )
 the initial colonizing bacteria vary with
3. Normal adult colon
the food source of the infant
 96 – 99 % of the resident flora consist of
 the environment ( maternal vagina,
anaerobes Six major phyla predominates
fecal or skin microbiota ), is a major
 bacteroidetes, firmicutes, actinobacteria,
factor in determining the early major
verrucomicrobiota,fusobacterial and
profile
proteobacteria.
In breast-fed infants
 the intestinal microbiota is dominated by 3 major categories of the functions of the
Bifidobacteria which accounts for more intestinal microbiota
than 90% In bottle-fed infants 1. Protective functions in which the resident
 a more mixed flora exist in the bowel, bacteria displace and inhibit potential
lactobacilli are less prominent pathogens indirectly by competing with
Infants at the intensive care nurseries nutrients and receptors or directly through the
 colonized by enterobacteriacae ( klebsiella, production of antimicrobial factors such as
citrobacter, enterobacter ). bacteriocins and lactic acids.
Esophagus 2. Commensal organisms are important for
 contains microorganisms arriving with the development and function of the mucosal
saliva and food. immune system
Stomach  Induce the secretion of IgA
 High acidity of the gastric juice, very few  Influence the development of the
bacteria ( mainly acid-tolerant lactobacilli) intestinal humoral immune system
 Helicobacter pylori colonizes the stomach,  Modulate local T cell responses and
which has been the cause of gastric ulcers. cytokines profiles

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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

3. Consist of a broad range of metabolic NORMAL MICROBIOTA OF THE VAGINA


functions Aerobic lactobacilli
 appear in the vagina soon after birth and
Metabolic functions persist as long as the pH remains acidic.
 Neutral pH ( until puberty ) mixed flora of
1. microbiota of the small intestine can cocci and bacilli is present.
contribute to the amino acid requirements At puberty
of the host, if they are not provided with  aerobic and anaerobic lactobacilli reappear
the diet itself in large numbers.
2. intestinal bacteria produce short chain  contribute to the maintenance of acid pH
fatty acids that control intestinal epithelial through the production of acid from
cell differentiation glycogen
3. they synthesize vitamin K, biotin and  This is important mechanism in preventing
folate and enhance ion absorption establishment of harmful microorganisms
4. certain bacteria metabolize dietary in vagina
carcinogens and assist with Lactobacilli
fermentation of non-digestible dietary  can be suppressed by administration of
residue antimicrobial drugs which cause the
5. gut bacteria can influence fat deposition in increase in numbers of yeast or various
host, leading to obesity bacteria, thus irritation and inflammation
occur.
Effect of antimicrobial drugs After menopause
1. range from self-limiting  lactobacilli diminish in numbers and mixed
2. life threatening pseudomembranous colitis flora set-in.
Intentional suppression of fecal flora is  25 % of women of childbearing age, the
commonly done by preoperative oral normal vaginal flora includes group B
administration of insoluble drugs streptococci.
 Example : neomycin + erythromycin Newborn
( aerobes ) metronidazole ( anaerobes )  may acquire group B strep , which cause
Anaerobic flora of the colon (Bacteroides neonatal sepsis and meningitis.
fragilis, clostridia, peptostreptococci) Normal vaginal flora
 play a main role in abscess formation  alpha hemolytic streptococcus
originating from bowel perforation.  anaerobic streptococcus
Prevotella bivia and Prevotella disiens ( peptostreptococcus, prevotella species,
 are important in abscesses of the clostridia, gardnerella vaginalis,
pelvis. ureaplasma urealyticum, also listeria or
Anaerobes in the intestinal tract mobiluncus species.
 are the primary agents of intra- Presence of lysozyme in the cervical mucus has
abdominal abscesses and peritonitis. antibacterial activity.
Bowel perforations produced by appendicitis, Predisposing factor in recurrent urinary tract
cancers, infarction, surgery or gunshot wounds infection
 almost always seed the peritoneal  due to the heavy flora resembling that of
cavity and adjacent organs with normal the perineum and perianal area in the
flora. vaginal introitus.

NORMAL MICROBIOTA OF THE URETHRA NORMAL MICROBIOTA OF THE CONJUNCTIVA


Both sexes of the anterior urethra contain small Predominant organisms
numbers of of same type of microorganisms found  diphtheroides , S. epidermidis
in the skin and perineum non-hemolytic streptococcus, Neisseria specie,
 S. epidermidis alpha hemolytic Moraxella specie
streptpcocci, Enterococci and The normal flora of the conjunctiva is held in
Diphtheroids check by the presence of lysozyme in the tears.
 These organisms are found in normally
voided urine in numbers of 10 to the 2 PRINCIPLES OF DISEASE AND EPIDEMIOLOGY
and 104/ml  Unbroken skin and mucous membrane are
effective barriers against microbial
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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

invasions and antibodies to destroy 2. Prevalence of a disease


microbes  is the number of people in a population
who develop a disease at a specific time,
Epidemiology regardless of when it first appeared.
 Infectious disease is the primary cause of  It takes into account both old and new
death worldwide cases and indicator of how seriously and
Pathology how long a disease affects a population.
 is the scientific study of diseases 3. Sporadic disease
 it concerned with the cause or etiology of  a particular disease occurs only
disease occasionally.
 it deals with pathogenesis ( manner in 4. Endemic disease
which a disease develops )  a disease constantly present in a population
 it is concerned with the structural and 5. Epidemic disease
functional changes brought about by the  many people in a given area acquire a
disease with their final effects on the body certain disease in a relatively short period
Infection 6. Pandemic disease
 is the invasion or colonization of the body  an epidemic disease that occurs worldwide
by pathogenic microorganisms.
 may exist in the absence of detectable PREDISPOSING FACTORS
disease. ex,. AIDS; E coli  one that makes the body more susceptible
Disease to a disease and may alter the course of the
 occurs when an infection results in any disease
change from state of health. a. gender
 an abnormal state in which part or all of the b. genetic
body is not properly adjusted or incapable c. Climate and weather
of performing its normal functions d. Inadequate nutritions
e. Fatique
CLASSIFICATION OF INFECTIOUS DISEASES f. Habits
•Every disease that affect the body alters body g. Lifestyle
structures and functions in particular ways and h. Occupation
these alterations are indicated by several kinds of i. preexisting illness
evidence. j. chemotherapy
 ex. The patient may experience certain k. emotional disturbances
symptoms or change in body functions
( pain or malaise ) The patient may exhibit DEVELOPMENT OF A DISEASE
signs which the physician can observe and Once a microorganism overcomes the host’s
measure. defenses, development of the disease follows a
Syndrome certain sequence.
 specific group of symptoms or signs may 1. Incubation period – time interval between
always accompany a particular disease. the initial infection and the first appearance
of any signs or symptoms.
Communicable disease It depends on:
 any disease that spread from one host to  specific microorganism involved
another either directly or indirectly.  virulence ( degree of pathogenicity )
Contagious disease  number of infecting microorganisms
 any disease that is easily spread from one  resistance of the host
person to another 2. Prodromal period – is a relatively short
Non-communicable disease period that follows the period of incubation
in some diseases, characterized by early,
OCCURRENCE OF A DISEASE mild symptoms of disease.
1. Incidence of a disease 3. Period of illness – disease is most acute,
 is the number of people in a population person exhibits signs and symptoms of
who develop the disease during a disease. Person may recover or die at this
particular time period. period.
 This is an indicator of the spread of the 4. Period of decline – signs and symptoms
disease. subside
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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

5. Period of convalescence – person regains f. by insect vectors.


strength and the body returns to its 2. Nonliving reservoir
predeceased state. a. water
b. soil
THE SPREAD OF INFECTION  Soil harbors such pathogens as fungi which
Reservoirs of infection causes mycoses ( ringworms, systemic
 For a disease to perpetuate itself, there infections
must be a continual source of the  C. tetani and C. botulinum as part of normal
disease organisms intestinal microbiota of horses and cattle,
Sources can be either are found in soil where animal feces are
 a living organisms used for fertilizer.
 inanimate objects that provides a  Water contaminated by human feces and
pathogen with adequate conditions for other animal is a reservoir for several
survival and multiplication opportunity pathogens responsible for GI diseases.
for transmission.
Reservoirs TRANSMISSION OF DISEASE
 can be human, animal or nonliving The causative agents of disease can be transmitted
from reservoir to a susceptible host by
1. Contact transmission
Human reservoirs  is the spread of an agent of disease
 the principal living reservoir is the by direct contact, indirect contact or
human body. droplet transmission.
 Many people harbor pathogens and a. Direct transmission ( person to person
transmit them directly of indirectly to transmission )
others.  transmission by physical contact
 People with signs and symptoms of a between its source and a susceptible
disease may transmit the disease; host.
others harbor the pathogens and  Most common form kissing,
transmit to others w/o exhibiting s/s of touching and sexual contact.
illness called carriers b. Indirect transmission
 Human carriers play an important role  occurs when the agent of the
in the spread AIDS, typhoid fever and disease is transmitted from its
hepatitis reservoir to a susceptible host by
means of a non-living object
Reservoir of infection ( fomite ) contaminated syringes
1. Animal reservoir serve as fomite in the transmission
 both wild and domestic animals are of AIDS and hepa B.
living reservoir of microorganisms that c. Droplet transmission
can cause human diseases.  contact transmission in which
Zoonosis microbes are spread in droplets that
 are disease that occur primarily in wild travel only a short distance ( < 1 m
and domestic animals and can be from reservoir to host ).
transmitted to humans.  Example: influenza, pneumonia and
 The transmission of zoonoses to pertussis.
human can occur via one of many 2. Vehicle transmission
routes  is the transmission of a disease
a. by direct contact with infected agent by a medium; water, food or
animals air, blood, other body fluids, drugs
b. by direct contact with domestic per and intravenous fluids.
waste a. Waterborne transmission
c. by contamination of food and  pathogens are spread by water
water contaminated with untreated or
d. by air from contamination of hides, poorly treated sewage.
fur or leathers  Ex. Cholera, waterborne shigellosis,
e. by consuming infected animal leptospirosis
products b. Foodborne transmission
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microbiology
Lecturer: dr. adelina talavera
Topic: normal human biota

 pathogens are transmitted in foods that Nosocomial infections


are undercooked, poorly refrigerated or Compromised host
prepared under unsanitary conditions.  is one whose resistance to
c. Airborne transmission infection is impaired by disease,
 spread of agents of infection by droplet therapy or burns.
nuclei in dust that travel more than 1 2 principal conditions that can
meter from reservoir to host. compromise the host
 Microbes are discharged in fine spray 1. broken skin or mucous membranes
from the mouth and nose during 2. suppressed immune system
coughing and sneezing. 3. Chain of transmission
 Staphylococcus and streptococcus can  the principal routes of
survive on dust, spores produced by transmission of nosocomial
certain fungi. infections are direct contact
3. Vectors transmission from hospital staff
Arthropods to patients and from patients to
 are the most important group of disease patients and indirect contact
vectors– animals that can carry pathogens transmission through fomites
from one host to another. and the hospital ventilation
 transmit disease by 2 general methods system.
a. mechanical transmission – is the  ex, physician, nurses may
passive transport of pathogens on transmit microbiota to a patient
the insect’s feet or other body when changing or kitchen
parts. Ex, houseflies worker who carries salmonella
b. biological transmission – example can contaminate the food
is malaria supply.

NOSOCOMIAL ( HOSPITAL-ACQUIRED ) CONTROL OF NOSOCOMIAL


INFECTIONS INFECTIONS
Nosocomial infection It is important to reduce the number of
 one does not show any evidence of being pathogens to which patients are exposed
present or incubating at the time of by
admission to a hospital a. using aseptic techniques
 acquired as a result of hospital stay. b. handling contaminated materials
Result from interaction of several factors carefully
a. microorganisms in the hospital c. frequent and thorough hand
environment washing
b. compromised or weakened status d. educating staff members about
of the host basic infection control measures
c. chain of transmission in the e. using isolation rooms and wards
hospital

Microorganisms in the hospital


 the hospital environment is a
major reservoir for a variety of
pathogens.
 certain normal microbiota of
the human body are
opportunistic and present a
strong danger to the hospital
patient.
 Some microorganisms in the
hospital become resistant to
antimicrobial drugs that are
commonly used.
 Ex. Pseudomonas aeruginosa.

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