CHAPTER 5: NORMAL FLORA OF THE
Once born, the newborn normal flora is
HUMAN BODY
MICROBIAL ECOLOGY
- is the study of the relationships between
microorganisms and their environment.
Among these relationships is the relationship of
microbes with humans, and such include the
normal flora (or indigenous flora) of the human
body. Normal flora consists of the group of
organisms that inhabit the body of a normal
healthy individual in the community. These
indigenous flora may be non-pathogenic or
pathogenic and may at times behave as
opportunistic pathogens.
There are two types of flora, namely:
1. RESIDENT FLORA
2. TRANSIENT FLORA.
RESIDENT FLORA
- are organisms that are relatively of fixed types
and are regularly found in a given area of the
body at a given age.
TRANSIENT FLORA
- are those that inhabit the skin and mucous
membrane temporarily for hours, days, or weeks
and are derived from the environment.
NORMAL FLORA
- are beneficial to the human body because they
can inhibit the growth of pathogenic organisms
by priming the immune system of newborns.
- At the same time, normal flora protects the
body's organs and systems that are in direct
contact with the external environment and are
therefore subject to the attack of invasive
organisms.
- Normal flora do this by either competing with
invasive organisms for nutrients essential for
their growth or by producing substances that can
kill them.
- Normal flora synthesize important vitamins that
are essential to humans.
- Normal intestinal flora secrete vitamin K that is
needed for the activity of some clotting factors.
Other beneficial effects of normal flora include the
following:
1. Normal flora can prevent pathogenic
organisms from attaching to and penetrating the
skin and other tissues by producing mucin
which make it difficult for the pathogenic
organisms to attach to the tissues to produce
disease.
2. Normal flora in the intestines aid in the
digestion of food by producing enzymes such
as cellulase, galactosidase, and glucosidase.
3. Intestinal flora also help in the metabolism of
steroids. The healthy fetus is normally sterile
until birth, following the rupture of the bag of
water.
derived from the mother's genital tract during
delivery, from the skin and respiratory tract of
individuals who handled the newborn, and from
the environment.
- There are certain body tissues and fluids that
are normally sterile.
- Body fluids that are sterile include the
cerebrospinal fluid (CSF), synovial fluid, and
blood.
- In the blood, there may be low transient
bacteremia brought about by physiologic
trauma.
- The sterile tissues include the urinary bladder,
uterus, fallopian tubes, middle ear, and
paranasal sinuses.
- Presence of bacteria in these tissues and body
fluids may lead to serious infections in these
areas.
- For example, bacteria in the CSF can gain entry
into the central nervous system, leading to a
potentially fatal encephalitis.
NORMAL FLORA ON DIFFERENT SITES
OF THE BODY
SKIN
- The skin is the part of the human body that is in
constant contact with the environment, making it
the most exposed to microorganisms. There are
certain factors that eliminate non-resident flora
from the skin, namely:
1. Lysozyme in the skin
2. Acidic ph of the skin due to sweat;
3. Free fatty acids in sebaceous
secretions;
4. The constant sloughing off of the
skin.
- The normal flora of the skin consists mainly of
BACTERIA AND FUNGI.
The microorganisms vary depending on the region of
the skin. The skin may be divided into three regions:
1. axilla, perineum, and toe webs;
2. hand, face, and trunk;
3. upper arms and legs.
SKIN OF THE AXILLA, PERINEUM, AND TOE
WEBS
is characterized by having higher moisture levels,
higher body temperature, and higher levels of
surface lipids.
These regions have more compared to the others
and are predominantly inhabited by gram-negative
bacilli.
 Dry sites (e.g., hands, forearms, feet, legs) have
diverse flora because of their exposure to the
environment. microorganisms Predominant flora in
these areas include Staphylococcus epidermidis and
Staphylococcus
Most microorganisms in the skin are found in its
superficial layers (stratum corneum) and hair follicles.
Anaerobes inhabit the deeper structures and layers of
the skin, such as hair follicles, sebaceous glands, and
sweat glands. Table 5.1 summarizes the various
microorganisms
MOUTH AND RESPIRATORY TRACT
The tongue and buccal mucosa are inhabited
mostly by Streptococcus viridans group, which
includes S. mutans, S. milleri, S. salivarius, and S.
sanguis. Although they are part of the normal flora of
the mouth, the viridans streptococci have been
implicated in the pathogenesis of dental caries. The
gingival crevices and the tonsillar crypts are primarily
inhabited by anaerobic flora.
The normal flora of the pharynx and trachea are
similar to those found in the oral cavity. However,
there may be transient carriage in the pharynx of
potentially pathogenic organisms. These include
Haemophilus influenzae, Streptococcus pneumoniae,
Neisseria meningitidis, and Mycoplasma.
In the upper respiratory tract, initial colonization
by pathogenic organisms may be seen. These include
Neisseria meningitidis, Corynebacterium diphtheriae,
and Bordetella pertussis. The lower respiratory tract is
usually sterile and organisms that reach this region are
usually destroyed by the defense mechanisms of the
body such as the alveolar macrophages.
The normal flora in the conjunctivae are very
scanty because they are held in check by the flow of
tears that contain lysozyme. The lysozyme may
interfere with the cell wall synthesis of organisms.
However, some bacteria may transiently colonize the
conjunctiva including Neisseria, Moraxella, and
Corynebacterium. Staphylococci and streptococci may
also be present.
CONJUNCTIVA
Digestive Tract
The esophagus contains transient mouth flora.
Minimal bacteria may be found in the stomach due to
the relatively hostile environment in the stomach.
Bacteria that may be found in the stomach are
those that may be swallowed with the food or those
that are dislodged from the mouth.
The acidity in the environment of the stomach is
further increased after meals because of the release of
gastric acid. However, there are certain bacteria that
are able to survive in the acidic environment of the
stomach.
One of these is HELICOBACTER PYLORI, the
most common cause of duodenal ulcer. This organism
produces urease that causes alkalinization of gastric
acid thereby enabling it to colonize the stomach.
The number of bacterial flora differs between
the small intestine and large intestine. In the small
intestine, scanty flora may be found due to the constant
peristaltic movement of the intestines.
Most of the bacteria cultured in the small intestine
include STREPTOCOCCI, LACTOBACILLI, AND
BACTEROIDES WHICH ARE ALL
TRANSIENT.
The number of bacterial flora in the LARGE
INTESTINE is far greater than in the SMALL
INTESTINE.
The colon is inhabited predominantly by
ANAEROBES (95%-99%) which includes
BACTEROIDES FRAGILIS (most common),
Bifidobacterium/Lactobacillus bifidum (predominant
in breast-fed infants), EUBACTERIUM,
PEPTOSTREPTOCOCCUS, and CLOSTRIDIUM.
In bottle-fed infants, the predominant intestinal flora
is LACTOBACILLUS ACIDOPHILUS. About 1%-
4% of the flora of the colon are facultative aerobes,
predominantly Escherichia coli and other
Enterobacteriaceae.
INTESTINAL FLORA play important roles in
the body, namely:
1. Synthesis of vitamin b complex and
vitamin k;
2. Conversion of bile into bile acids;
3. Competition with transient flora for
nutrients;
4. Prevention of colonization of the
intestines by transient flora;
 5. Production of potentially pathogenic
end-products of metabolism that are
toxic to transient flora.
- After menopause, the vaginal pH increases once
GENITOURINARY TRACT
The urinary tract is sterile above the DISTAL 1
CM OF THE URETHRA. In the anterior urethra, the
predominant flora isolated are S. epidermidis,
enterococci, and diphtheroids. In both males and
females, Mycobacterium smegmatis may be found as
- Lactobacillus plays a crucial role in preventing
GONOCOCCAL INFECTION by producing
lactic acid that adds to the acidity of the vagina.
Young girls are more prone to the development
of gonococcal infection compared to adult
women because the normal acidic pH of the
vagina as well as normal vaginal flora are not yet
fully developed.t
more due to the lessened production of glycogen.
Normal flora that predominate during this period
are similar to those found during pre-puberty.
Most of these flora are derived from the skin and
from the colon. Fungi such as Torulopsis and
Candida may also be found (10% -30%).
Conditions that will allow the overgrowth of
these fungi (e.g., intake of antibiotics) can lead to
vaginal infections such as vaginitis.

normal commensals in their secretions. In addition,

Gardnerella vaginalis, bacteroides, and alpha
streptococci may be found in penile urethra. The
female urethra is either sterile or contains
Staphylococcus epidermidis.

- Vaginal flora varies depending on the age,

hormonal levels, and vaginal pH of the host. In
female infants, the predominant vaginal flora is
Lactobacillus spp.
- From 1 month of age until puberty, there is
cessation of glycogen secretion making the
vaginal pH higher (around 7.0). The
microorganisms that may inhabit the vagina at
this time include Staphylococcus epidermidis,
Streptococci, diphtheroids, and Escherichia coli.
- At the onset of puberty, there is resumption of
glycogen secretion making the vaginal pH acidic.
Predominant flora include Lactobacillus
acidophilus, corynebacteria, peptostreptococci,
streptococci, Bacteroides, and staphylococci.