NORMAL FLORA OF THE HUMAN BODY

JANUARY 30, 2008

MUTUALISTIC RELATIONSHIP

HOST NUTRITIONAL BENEFITS STIMULATION OF THE IMMUNE SYSTEM COLONIZATION STRATEGIES

ORGANISM NUTRIENT SUPPLY STABLE ENVIRONMENT

REASON FOR THEIR PREFERRED SITES

TISSUE TROPISM
TISSUE PREVALENCE/PREDILECTION PRESENCE OF AN ESSENTIAL GROWTH FACTOR INHOSPITABLE ENVIRONMENT

NORMAL FLORA’S SURFACE COMPONENTS FIMBRIAE, CAPSULES, PILI

REASONS FOR COLONIZATION

BACTERIAL BIOFILMS

TISSUE TROPISM OF LACTOBACILLUS IN THE G.U.T.

N.gonorrhoeae: pili

SKIN

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HIGHEST NUMBER IN THE MOIST AREAS MOST SUPERFICIAL LAYERS, UPPER HAIR FOLLICLES S.epidermidis Micrococcus spp. Corynebacterium

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NONPATHOGENIC COMMENSAL/MUTUALISTIC/PARASITI C MAY PROTECT AGAINST FUNGAL COLONIZATION

Micrococcus spp.

S.epidermidis

RESPIRATORY TRACT

NOSTRIL S.epidermidis S.aureus** Corynebacterium SINUSES STERILE

URT STREPTOCOCCUS H.influenzae LRT STERILE

LOWER RESPIRATORY TRACT

LRT EPITHELIUM

RESP.TRACT CILIA

ORAL CAVITY

NUTRIENTS, DEBRIS, SECRETIONS:IDEAL ENVIRONMENT AT BIRTH - STERILE S.salivarius – UP TO 9 MONTHS OF AGE S.mutans, S.sanguis – AFTER TEETH ERUPTION Bacteroides – PUBERTY ANAEROBES - GINGIVA

ORAL CAVITY

PREVENT GROWTH OF PATHOGENS NUTRIENT DEPLETION PRODUCE FATTY ACIDS, PEROXIDES STIMULATE LOW LEVELS OF IG, CROSS REACT CAUSE HARM IF THEY ENTER TISSUES B.melanogenicus - WOUNDS STREPTOCOCCUS – HEART VALVES, SUBACUTE BACTERIAL ENDOCARDITIS

DENTAL PLAQUE

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LEADS TO CARIES, PERIODONTAL DISEASE BIOFILM – 300 TO 500 CELL THICKNESS 60-70%PLAQUE VOLUME: BACTERIA MOST COMMON ORGANISM S. sanguis, S.mutans

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S.mutans PRODUCE LACTIC ACID FROM DIETARY CARBOHYDRATES DEMINERALIZES TEETH ENAMEL LACTOBACILLI,ACTINOMYCES: SECONDARY INVADERS PERIODONTAL DISEASE: ACTINOMYCES GINGIVA, ALVEOLAR BONE

CONJUNCTIVA

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MOST DOMINANT S. epidermidis PROPRIONIBACTERIUM spp MECHANICAL WASHING OF TEARS LYZOZYME LITTLE/NO OPPORTUNITY FOR COLONIZATION

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N.gonorrhoeae C.trachomatis PRESENCE OF SIALIC ACID RECEPTORS NEWBORN MAY BE INFECTED PROPHYLACTIC ANTIBIOTIC AT BIRTH

NYC PROTOCOL
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TETRACYCLINE ERYTHROMYCIN 1%SILVER NITRATE

UROGENITAL TRACT
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URINE- STERILE FLUSHING OF URINE ANTERIOR URETHRA S.epidermidis ENTERIC BACTERIA CONTAMINANTS

VAGINA Lactobacillus acidophilus (Doderlein’s bacillus) METABOLIZES GLYCOGEN TO LACTIC ACID LOW pH PREVENTS GROWTH OF MOST BACTERIA, YEAST (CANDIDA)

GIT
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INFLUENCED BY THE AGE, DIET, SPECIFIC SITE ESOPHAGUS BACTERIA IN FOOD, SALIVA STOMACH RARE LACTOBACILLI HELICOBACTER PYLORI

Helicobacter pylori

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RELATED TO GASTRIC ULCERS, CANCER CLASS I CARCINOGEN (WHO) 20-30 YEARS INFECTION---CA MOST COMMON BACTERIAL INFECTION

H.PYLORI

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DETECTED BY THE C-13 OR C-14 BREATH TEST ANTIBODY DETERMINATION TEST ENDOSCOPY

GIT NORMAL FLORA

PROXIMAL SMALL INTESTINE SPARSE GR(+) FLORA Lactobacilli S.faecalis DISTAL SMALL INTESTINE Coliforms (gram – bacilli) Bacteroides

LARGE INTESTINE +++COLIFORMS ANAEROBIC BACTEROIDES ANAEROBIC LACTOBACILLI METHANOGENIC BACTERIA OUTNUMBER E.COLI 1,000:1 UP TO 10000:1

GIT IN INFANTS
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BIRTH – STERILE GIT BREASTFED INFANTS 90% BIFIDOBACTERIA COW’SMILK, SOLID FOOD BACTEROIDES STREP ENTERICS

GIT TROPISM

GRAM (+) CAPSULES LIPOTECHOIC ACIDS IN THEIR WALLS GRAM (-) FIMBRIAE BINDS TO THE GLYCOPROTEINS ON THE CELL SURFACE

BENEFITS OF THE INTESTINAL FLORA
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E.COLI SYNTHESIZES VITAMIN K COMPETE FOR ATTACHMENT SITE OF PATHOGENIC SPECIES STIMULATES GROWTH OF LYMPHOID TISSUES PRODUCTION OF CROSS REACTIVE ANTIBODIES

Predominant bacteria at various anatomical locations in adults. 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, Gramnegative rods and cocci Lower respiratory tract none

GasTrointestinal

tract

            stomachHelicobacter 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

Streptococcus pyogenes Streptococcus mutans Streptococcus salivarius Streptococcus pneumoniae Staphylococcus aureus Neisseria gonorrhoeae

Cell-bound protein (Mprotein) Cell- bound protein (Glycosyl transferase) Lipoteichoic acid Cell-bound protein (cholinebinding protein) Cell-bound protein N-methylphenyl- alanine pili

Pharyngeal epithelium Pellicle of tooth Buccal epithelium of tongue Mucosal epithelium Mucosal epithelium Urethral/cervical epithelium

Enterotoxigen ic E. coli Uropathogeni c E. coli Bordetella pertussis Vibrio cholerae Treponema pallidum Mycoplasma Chlamydia

Type-1 fimbriae P-pili (pap) Fimbriae ("filamentous hemagglutinin") N-methylphenylalanine pili Peptide in outer membrane Membrane protein Unknown

Intestinal epithelium Upper urinary tract Respiratory epithelium Intestinal epithelium Mucosal epithelium Respiratory epithelium Conjunctival or urethral epithelium