Dr Chileshe Lukwesa-Musyani

MD, MPH, MSc

 INTRODUCTION
• Many people wrongly think of microbes present at body
surfaces as ‘germs’ that should be routinely avoided.

• However, most of these microbes co-exist peacefully

with the human body, often providing beneficial
aspects.
 DEFINITION
• Human flora are microorganisms that constantly inhabit the
human body .

• Normal flora, by definition, do not cause disease in healthy

individuals.

• they include bacteria ,fungi.

• bacteria are the most numerous and obvious microbial

components of the normal flora.

– some are useful for the human host, while

– the majority have no known beneficial or harmful effect.
 Microbes and human: Normal flora
• An adult human body • There are more bacteria
consists of ~ 1013(10 in just one person’s
million million) mouth than there are
prokaryotic cells. people in the world.

• Before birth:
– foetus exists in sterile
environment.
 Microbes and human: Normal flora

Animal bodies - favourable environments;

• rich in organic nutrients and growth factors,

• relatively constant conditions of pH and osmotic

pressure,

• highly constant temperature (warm-blood

animals).
 Microbes and human: Normal flora
3 categories :
• resident flora (indigenous flora).
– Always present on or in the human body

• transients
– Present only in a short time

• opportunists
– Some flora can cause disease in compromised
host
 Associations Between Humans and the
Normal Flora
• Mutualistic. - Both host and bacteria are thought to derive
benefit from each other.

• Parasitic (live at the expense of their host)

• Pathogenic (capable of producing disease)

• Endogenous diseases - Diseases that are produced by the

normal flora in their host.
– Most endogenous bacterial diseases are opportunistic infections,
meaning that the the organism must be given a special opportunity
of weakness or let-down in the host defenses in order to infect

• Commensal relationship - no apparent benefit or harm to

either organism during their association
 Tissue specificity

• Most members of the normal bacterial

flora prefer to colonize certain tissues and
not others.

– This "tissue specificity" is usually due to

properties of both the host and the bacterium.

– Usually, specific bacteria colonize specific

tissues by one or another of these mechanisms.
 Tissue specificity
1. Tissue tropism - is the bacterial preference or
predilection for certain tissues for growth.

– explanation for tissue tropism is that the

• host provides essential nutrients and growth
factors for the bacterium, in addition to suitable
oxygen, pH, and temperature for growth
➢ E.g. Lactobacillus acidophilus, colonizes the
vagina because glycogen is produced which
provides the bacteria with a source of sugar
that they ferment to lactic acid.
 Tissue specificity
2. Specific adherence
– Most bacteria can colonize a specific tissue or
site because they can adhere to that tissue or
site in a specific manner that involves
complementary chemical interactions between
the two surfaces.
 Tissue specificity
3. Biofilm formation
Some of the indigenous bacteria construct
biofilms on a tissue surface.

Many biofilms are a mixture of microbes,

although one member is responsible for
maintaining the biofilm and may predominate.
 Biofilm formation

The classic biofilm that involves components of the normal

flora of the oral cavity is the formation of dental plaque on
the teeth.
 The Composition of the Normal Flora
• The normal flora of humans are exceedingly complex and
consist of more than 200 species of bacteria.

• The makeup of the normal flora may be influenced by

various factors, including
– genetics,
– age,
– sex,
– stress,
– nutrition
– diet of the individual.
 Normal Flora of the Skin
• The adult human is covered with approximately 2 square
meters of skin.

• Density and composition of the normal flora of the skin

varies with anatomical locale.
– The high moisture content of the axilla, groin, and areas
between the toes supports the activity and growth of
relatively high densities of bacterial cells

– Most bacteria on the skin are sequestered in sweat

glands.
 Normal Flora of the Skin
• Gram-positive cocci (Staphylococcus epidermidis and
Micrococcus sp.)

– Corynebacteria
– Propionibacterium sp. (produce fatty acids that inhibit
the growth of fungi and yeast on the skin)
– staphylococci

• Sometimes potentially pathogenic Staphylococcus aureus

is found on the face and hands in individuals who are nasal
carriers.
 Normal Flora of the Conjunctiva
• number of organisms is usually small.

– Staphylococcus epidermidis
– coryneforms (Propionibacterium acnes) are dominant.
– Staphylococcus aureus, some streptococci, Haemophilus
sp. and Neisseria sp. are occasionally found.

The conjunctiva is kept moist and healthy

– lachrymal glands.
– Blinking wipes the conjunctiva every few seconds
– Lachrymal secretions (tears) also contain bactericidal
substances including lysozyme.
 Normal Flora of the Respiratory Tract
Upper respiratory tract (nasopharynx).
• Nares (nostrils) are always heavily colonized, predominantly with
Staphylococcus epidermidis and corynebacteria,

• About 20% of the general population are colonised with

Staphylococcus aureus,

Sinuses, in contrast are sterile.

• Pharynx (throat) –
– streptococci and various Gram-negative cocci.
– Sometimes pathogens such as Streptococcus pneumoniae,
Streptococcus pyogenes, Haemophilus influenzae and Neisseria
meningitidis colonize the pharynx.
 Normal Flora of the Respiratory Tract
Lower respiratory tract (trachea, bronchi, and pulmonary
tissues)
– is virtually free of microorganisms, mainly because of
the efficient cleansing action of the ciliated epithelium
which lines the tract.
– coughing, sneezing, swallowing, etc.

– damaged respiratory tract epithelium as in bronchitis or viral

pneumonia, susceptible to infection by pathogens such as H.
influenzae or S. pneumoniae descending from the nasopharynx.
 Normal Flora of the Urogenital Tract
• Urine is normally sterile

• Anterior urethra,
– Staphylococcus epidermidis, Enterococcus faecalis and
some alpha-heamolytic streptococci.
– some enteric bacteria (e.g. E. coli, Proteus) and
corynebacteria, which are probably contaminants from
the skin, vulva or rectum

• Vagina
– colonized soon after birth with corynebacteria,
staphylococci, streptococci, E. coli, and a lactic acid
bacterium Lactobacillus acidophilus
 Normal Flora of the Urogenital Tract
• Prepubescent and postmenopausal
– Primarily staphylococci
– Corynbacteria

• Reproductive age
– Facultative bacteria such as enterobacteriacae,
streptococci, staphylococci
– Anaerobes such as lactobacilli, anaerobic non-spore-
forming bacilli and cocci and clostridia

• Many women carry group B beta haemolytic streptococci

(Streptococcus agalactiae) which may be transmitted to
the neonate-→systemic disease
A Lactobacillus species in association with a vaginal epithelial
cell.
 Normal Flora of the Oral Cavity
The presence of nutrients, epithelial debris, and
secretions makes the mouth a favourable habitat for
a great variety of bacteria.

Oral bacteria include

– streptococci,
– lactobacilli,
– staphylococci and
– corynebacteria, with
– a great number of anaerobes, especially bacteroides.
 Normal Flora of the Gastrointestinal Tract
Upper GI tract of adult humans
– esophagus - contains only the bacteria swallowed with
saliva and food.
– stomach few bacteria (mainly acid-tolerant)
• Helicobacter pylori cause of gastric ulcers
 Normal Flora of the Gastrointestinal Tract
• Proximal small intestine
– sparse Gram-positive flora, consisting mainly of
lactobacilli. This region has about 105 – 107 bacteria
per ml of fluid and Enterococcus faecalis

• Distal part of the small intestine

• contains greater numbers of bacteria (108/ml)
• coliforms (E. coli and relatives) and
• Bacteroides
• lactobacilli and
• enterococci.
 Normal Flora of the Gastrointestinal
Tract
• Large intestine (colon)
– qualitatively similar to that found in feaces.
• 1011/ml feaces.
• Coliforms more prominent
• enterococci, clostridia and lactobacilli
• (predominant species are anaerobic Bacteroides and
anaerobic lactic acid bacteria in the genus
Bifidobacterium (Bifidobacterium bifidum).)
 Predominant bacteria at various anatomical locations in adults.

Anatomical Location Predominant bacteria

Skin Staphylococci and corynebacteria
Conjunctiva sparse, Gram-positive cocci and Gram-negative
rods
Oral cavity
teeth streptococci, lactobacilli
mucous membranes streptococci and lactic acid bacteria
Upper respiratory tract
nares (nasal membranes) staphylococci and corynebacteria
pharynx (throat) streptococci, neisseria, Gram-negative rods and
cocci
Lower respiratory tract none
Gastrointestinal tract
stomach Helicobacter pylori (up to 50%)
small intestine lactics, enterics, enterococci, bifidobacteria
colon bacteroides, lactics, enterics, enterococci,
clostridia, methanogens
Urogenital tract
anterior urethra sparse, staphylococci, corynebacteria, enterics
vagina lactic acid bacteria during child-bearing years;
otherwise mixed
 Beneficial Effects of the Normal Flora

1. synthesize and excrete vitamins in excess of their

own needs, which can be absorbed as nutrients by
their host.
– enteric bacteria secrete Vitamin K and Vitamin B12, and
lactic acid bacteria produce certain B-vitamins.

2. Prevent colonization by pathogens by competing for

attachment sites or for essential nutrients.
 Beneficial Effects of the Normal Flora

3. Antagonize other bacteria through the production of

substances which inhibit or kill nonindigenous species.
– nonspecific fatty acids and peroxides to highly
specific bacteriocins, which inhibit or kill other
bacteria.

4. Stimulate the development of certain tissues, i.e., the

caecum and certain lymphatic tissues (Peyer's patches)
in the GI tract.
 Beneficial Effects of the Normal Flora

5. Stimulate the production of natural

antibodies.
– Low levels of antibodies produced against
components of the normal flora are known to
cross react with certain related pathogens,
and thereby prevent infection or invasion
 Harmful Effects of the Normal Flora
1. Bacterial synergism between a member of the normal
flora and a potential pathogen.
– one organism is helping another to grow or survive.

2. Competition for nutrients Bacteria in the

gastrointestinal tract may get to some of our
utilizable nutrients before we are able to absorb
them.
 Harmful Effects of the Normal Flora

3. Induction of a low grade toxemia Minute amounts of

bacterial toxins (e.g. endotoxin) may be found in the
circulation.

4. The normal flora may be agents of disease. Members of

the normal flora may cause endogenous disease if they
reach a site or tissue where they cannot be restricted
or tolerated by the host defenses.
 Harmful Effects of the Normal Flora

4. Transfer to susceptible hosts

– This includes the pathogens that colonize the upper

respiratory tract such as Neisseria meningitidis,
Streptococcus pneumoniae, Haemophilus influenzae
and Staphylococcus aureus, and potential pathogens
such as E. coli, Salmonella or Clostridium in the
gastrointestinal tract.
END OF LECTURE