Reviewer for Normal Microbial Flora of the Human Body
epidermidis or due to
What is the importance of the normal flora of the body?
- The normal flora is important because without it,
the invading pathogens or bacteria will be the ones
to dominate the body by taking all the nutrients,
and this is called Bacterial Antagonism
o The normal flora prevents the invading
pathogens from dividing by secreting
antimicrobial agents
- They aid in Digestion through the interconversion?
Of bile into urobilinogen & stercobilinogen
o And the synthesis of Vitamin K
- It also helps in producing antibodies when there is
an invading pathogen in the body
Normal Microbial Flora
- denotes the population of microorganisms that
inhabits the skin and mucus membranes of the
gastrointestinal tract healthy normal persons.
o Mucus membrane inserts the vagina that
has Lactobacillus acidophilus which
converts glycogen into lactic acid that
lowers the pH of the vagina and inhibits the
growth of bacterial pathogens such as
Nocardia asteroides or Gardnerella
vaginalis which is the causative agent of
bacterial vaginosis
 Gardnerella vaginalis invades when
the pH of the vagina increases that
happens during hormonal changes
 During menopause where the
hormones of the patient are
inactive, there will be no glycogen
in the vagina and Lactobacillus
acidophilus diminish that will
increase the pH level
- the skin and mucus membranes always harbor a
variety of microorganisms that can be arranged in
two groups:
1. The resident flora consists of relatively fixed types
of microorganisms regularly found in a given area at
a given age.
a. Newborn babies do not have normal flora
yet until they come into contact with other
persons or when breastfeeding.
2. The transient flora consists of nonpathogenic or
potentially pathogenic (depending on the level of
immunity of the patient) microorganisms that
inhabit the skin and mucus membranes for hours,
days or weeks; it is derived from the environment
(Staphylococcus epidermidis which is one of the
normal flora of the skin and is the most abundant
normal flora in the skin that prevents the growth of
other organisms specifically the Staphylococcus
aureus), does not produce disease, and does not
establish itself permanently on the surface.
a. Staphylococcus epidermidis can be an
opportunistic pathogen when they are
inoculated in the blood which causes
sepsis. When the sepsis is not treated, it
causes subacute bacterial endocarditis.
b. Staphylococcus epidermidis enters the
bloodstream via needles that are
contaminated with S.
improper cleaning of the venipuncture site.
- if the resident flora is disturbed by these transient
flora, it may colonize, produce disease and
proliferate.
o Pag nasobrahan ka ng antibiotics, you risk
killing your normal flora. Organisms that are
resistant to antibiotics such as Clostridium
difficile which is already a normal flora in
the intestine will then proliferate and cause
disease as the other normal flora are killed.
The disease is called Pseudomembranous
colitis.
The Role of Resident Flora
1. Members of the resident flora of the gut synthesize
vitamin K and aid in the absorption of nutrients.
2. Normal flora of the skin prevents colonization of
pathogens through “bacterial interference” /
bacterial antagonism.
- Bacterial interference is through:
a. competition for receptors or binding sites on
host’s cells.
b. competition for nutrients.
c. mutual inhibition by metabolic toxic product
(toxic to the pathogen).
d. mutual inhibition by antibiotic materials or
bacteriocins (are naturally occurring antibiotics in
the body).
- suppression of the normal flora clearly creates a
partial local void (nothingness or walang organism
sa part ng body na yon) that tends to be filled by
organisms from the body and behave as
opportunistic pathogens producing a disease.
- normal flora may also become opportunistic
pathogen and produce noninvasive diseases by
forcefully remove from the restrictions of that
environment and introduced to bloodstream or
tissues.
Eg. Viridans streptococci during tooth extraction or
tonsillectomy. Usually, the ones present in our
teeth is Streptococcus mutans
Bacterioides during trauma of the gut.
The Normal Flora of the Skin
- the resident microorganisms of the skin are:
1. Aerobic (thrive in the presence of oxygen) and
anaerobic (cannot live in the presence of oxygen)
diphtheroid bacilli (Corynebacterium diphtheriae
[FAE], Propionibacterium spp. [FANAE])
a. Obligate (only exist in area w/o oxygen)
aerobic and obligate anaerobic
b. Facultative aerobic (needs oxygen but can
live in areas without oxygen) and
facultative anaerobic (do not need oxygen
but can live in areas with oxygen)
2. Non-hemolytic aerobic and anaerobic staphylococci
(Staphylococcus epidermidis and other coagulase-
negative staphlococci, ocassionally Staphylococcus
aureus [FAE], and Peptostreplococcus spp. (they are
capnophilic meaning they love CO2) [FANAE])
a. Hemolytic means they destroy RBCs
 3. Gram-positive, aerobic, sporeforming bacilli that are
umbiquitous in air, water and soil (Bacillus subtilis
the most common).
4. Alpha-hemolytic streptococci (viridans streptococci)
and enterococci (Enterococcus spp.).
a. Alpha means partial lysis of RBCs
b. Gamma means there is no hemolysis of
RBCs
c. Beta means complete hemolysis
d. Delta an inner zone of Beta hemolysis and
outer zone of Alpha hemolysis (used for
Clostridium perfringens)
5. Gram-negative coliform (any bacteria found in
human feces) bacilli and Acinetobacter spp..
6. Acid fast, non-pathogenic mycobacteria occur in
sebaceous-rich sections (external ear, genetalia).
7. Fungi and yeast are often present on skin folds.
8. Non-pathogenic Neisseria spp.
- aerobes and anaerobes often join to form
synergistic infections of the skin and soft tissues
such as gangrene (dissolution of tissues),
necrotizing fasciitis (known as flesh eating bacteria),
and cellulitis (usually caused by Staphylococci &
Streptococci).
o Types of gangrene are the liquid gangrene
which are found in diabetic feet
o Gas gangrene that is caused by Clostridium
perfringens
The Normal Flora of the Mouth and Upper Respiratory
Tract:
- Nose: Corynebacterium diphtheriae, Staphylococcus
epidermidis, S. aureus, and streptococci.
o Corynebacterium diphtheriae is an
opportunistic pathogen that causes Pseudo
membrane that causes plaque in the
pharynx that traps other bacteria and cells.
It is hard to remove as the mucosa will also
be removed.
- Mouth and Oropharynx: Viridans streptococci,
aerobic and anaerobic staphylococci, gram-negative
diplococci (Neiserria lactamica, N. mucosa,
Moraxella catarrhalis), C. diphtheriae, occasional
lactobacilli.
- Teeth and Tonsilar Area: Viridans streptococci,
anaerobic spirochetes (non-pathogenic and the
pathogenic are Treponema which are the causative
agents of syphilis, Leptospira that causes
leptospirosis, and Genus Borrelia), Prevotella spp.
(P. melaninogenica), Fusobacterium spp., Rothia
dentocariosa., and Capnocytophaga spp., anaerobic
vibrios and lactobacilli, Actinomyces spp, protozoa
(Entamoeba gigivalis), and yeast (Candida albicans).
- Bronchii, Trachea and Laryngopharynx: non-
hemolytic and alpha-hemolytic streptococci
(Streptococcus pneumoniae becomes opportunistic
when it goes into the lungs by being pushed due to
increased mucus and passes its pathogenic genes
into its allies), and Neisseria spp., staphylococci,
Haemophilus influenzae, Mycoplasma pneumoniae,
Prevotella spp.
o COVID-19 or Rhinovirus which is the
causative agent of common colds. Every
viral disease decreases the WBC count of
the body <5.0. During viral infection, the
number of neutrophils decreases, and the
number of lymphocytes increases. The
normal flora notices the lower amounts of
N and this results to the opportunistic flora
to multiply. When these opportunistic
bacteria grow such as Streptococcus
pneumoniae, they stimulate mucus
producing cells and push these pathogenic
bacteria into the lungs and cause “tubig sa
baga”. It also causes the blockage of air
exchange in the alveoli and if there is no gas
exchange, there will be no breathing in the
patient that causes in lower oxygen
saturation that will be the cause of death
o When Streptococcus pneumoniae migrates
in the nose, it travels through the ears via
the use of the eustachian tube which is a
passage that connects the ears and the
nose by being pushed by mucus, and when
it reaches the ears, it causes Otitis media
(infection of the middle ear). When this
Otitis media is not treated it migrates into
the inner ear causing Otitis interna and if it
is still not treated then it progresses into
the brain and spinal cord causing
meningitis. Which is why when there is a
blockage in the eustachian tube due to
mucus when we have cold, we have
difficulty in hearing as well.
The Normal Flora of the Mouth and Upper Respiratory
Tract:
- infections of the mouth and respiratory tract are
usually caused by mixed oronasal flora, including
anaerobes.
- peridontal infections, sinusitis, perioral abscesses,
and mastoiditis may involved predominantly
Prevotella melaninogenica, Fusobacteria, and
peptostreptococci.
- aspiration of saliva (containing 10 2 of these
microorganisms and aerobes) may result in
necrotizing pneumonia, lung abcess, and
emphyema.
The Normal Flora of the Mouth and Upper Respiratory
Tract:
- Dental Caries
- is a disintegration of the teeth beginning at the
surface and processing inward.
- main organisms involved are Streptococcus mutans
and other viridans streptococci (S. salivarius),
peptostreptococci.
- other organisms that contributes in the
development of dental caries are Capnocytophaga
spp., Rothia dentocariosa.
1st: the enamel which is noncellular is demineralized
attributed by bacterial products of fermentation (formation
of dental plaque).
2nd: subsequent decomposition of dentin and cement
involves bacterial digestion of protein matrix.
3rd: involvement of the root nerve endings causing painful
inflammation.
Dental Caries
- When a tooth has organisms in it such as
Streptococcus mutans. This organism alone does
not cause dental caries unless you eat table sugar
(sucrose). Now, through the action of fermentation
of S. mutans, it converts the sucrose into Levans (is
the insoluble polymer of fructose) + Dextran (is the
insoluble polymer of glucose) which are water
insoluble polymers and are called slime.
- Kapag hindi ka nagmumog or nag toothbrush after
mo kumain ng merong sugar at merong S. mutans
sa tooth mo, mafferment yung sucrose into slime
where it will cover the tooth together with other
organisms or bacteria that are in that area. Dahil
water insoluble yung slime, hindi na siya maddetach
from the tooth unless you use acids, but these acids
can also deteriorate the enamel in the tooth.
- After producing the slime, tapos na yung trabaho
nung S. mutans and the other organisms na kasama
niya are the ones that will deteriorate the enamel
that causes the caries. The direction of the caries is
paloob ng tooth and the bacteria will secrete toxins
and acids from the fermentation that will further
digest the enamel.
- After progressing further inside the tooth and na
reach na nila yung root, dun palang mag sstart yung
pain or toothache.
The Normal Flora of the Intestinal Tract:
1. During birth, the GIT is sterile, but organisms will
soon introduced by food and milk, mostly are lactic
acid streptococci, lactobacilli, gram-positive non-
motile organisms (eg. Bifidobacterium spp.)
produces tolerable acid pH.
2. Newborns on intensive care nurseries tend to be
colonized by Enterobacteriaceae (Klebsiella
pneumoniae, Citrobacter freundii, and Enterobacter
aerogenes) all of them causes sepsis.
3. Adults has vast variety of normal GIT flora consisting
of non-pathogenic Enterobacteriaceae, enterococci
and other gram-positive cocci, few gram positive
bacilli, and other gram-negative rods. 96 – 99% are
anaerobes such as Bacterioides fragilis,
Fusobacterium spp, anaerobic lactobacilli, anaerobic
cocci (Peptostreptococci), 1 – 4% are facultative
aerobes (gram-negative coliform bacteria),
enterococci, and small numbers of protei (Proteus
vulgaris and P. mirabilis) Pseudomonads
(Pseudomonas aeruginosa, P. putida, P fluoresence
and others) lactobacilli, Candida spp., and other
organisms. They are known as fecal flora.
The Normal Flora of the Intestinal Tract:
- the intestinal flora are important because:
o they produce vitamin K.
o conversion of bile pigments, bile acids and
indole to urobilin and stercobilin
(urobilinogen and stercobilinogen will
become urobilin and stercobilin when they
are exposed to oxygen).
o absorption of nutrients and breakdown
products.
o Bacterial antagonism.
The Normal Flora of the Intestinal Tract:
1. Bacterial flora may produce ammonia (usually
caused by Proteus spp. because they secrete urease
which splits urea to form water H2O and ammonia
NH3) from the breakdown products that may
contribute to hepatic coma.
2. If these resident flora are inoculated in the
bloodstream, they can produce sepsis and
meningitis.
3. Over-drug medication may cause killing of some of
the drug-resistant resident flora and opportunistic
infection to other may occur such as Staphylococci,
Enterobacters, Enterococci, Protei, Pseudomonas,
Clostridium deficille, and yeasts.
4. The anaerobic flora of the colon including
Bacterioides fragilis, Clostridia, Peptostreptococci,
plays an important role in abscess formation
originating in perforation of the bowel.
5. Prevotella bivia and P. disiens are important in
pelvis abscess.
6. Feeding of large amounts of Lactobacillus
acidophilus may result in temporary establishment
in the gut with concomitant partial supression of
the other gut flora.
The Normal Flora of the Intestinal Tract:
- the organisms that are not usually present in the gut, thus
considered as pathogens are:
- Helicobacter pylori (causative agent of pyloric
ulcers)
- Yersinia pestis (black death), Y.
pseudotuberculosis (causative agent of enterocolitis
and sepsis), Y. enterocolitica (same with Y.
pseudotuberculosis)
- Campylobacter jejuni (most common cause of
gastroenteritis)
- Pathogenic Escherichia coli (EIEC, ETEC, EHEC, EAEC)
- Vibrio cholerae
- Shigella dysenteriae, S. sonnei, S. flexneri, S. boydii
- Salmonella typhi
The Normal Flora of the Vagina:
1. Mostly dominated by Lactobacillus acidiphilus that
ferments lactose, glycogen, and other carbohydrates to
lactic acid responsible for the acidity of the vagina.
Menopause:
-the normal lactobacilli are suppressed and replaced by
mixed flora of cocobacilli (Gardnerella vaginalis), yeasts,
group B streptococci (S. agalactiae that causes UTI aside
from the invasion in the vagina), alpha-hemolyic
streptococci (Enterococci & S. bovis), anaerobic
streptococci, Prevotella spp., clostridia, Ureaplasma
urealyticum (STI or sexually transmitted infection), and
sometimes Listeria monocytogenes (Enterobacteriaceae
that causes diseases on newborns), and Mobinculus spp.
with the diminishing acidic pH (pH becomes alkaline
favoring the growth of these organisms.

o Gardnerella vaginalis sticks to the side of an

epithelial cell

The Normal Flora of the Conjunctiva:

1. The predominant normal flora are diphtheroids,

Staphylococcus epidermidis, and non-hemolytic
streptococci.

2. Neiseriae and gram-negative bacilli resembling

haemophili (eg. Moraxella spp. that causes sore eyes and
blindness when there is a decrease in immunity) may also
present.