University of Health Sciences

Faculty of Pharmacy

General Bacteriology
Normal microbial flora
3rd Year Pharmacy
Sophea Aing

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 Learning objectives
At the end of this session students should be able to:
 Know the selection criteria at the flora
 Describe definition of the normal flora
 Explain why the distinction between normal flora and pathogenic
flora is unclear
 Know body parts that can be colonized by the bacterial flora
 Know the organs are normally sterile
 Explain the two main criteria for micro-organism for their
persistence in the body
 Explain why you chose the neutralization of tissue receptors as
new therapeutic form
 Explain the benefits of the flora

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 Lesson plan
• Definition of commensal flora
• Part of the body colonized by flora
• Persistence of microorganism in the body
• Preference for a particular site
• Source of contamination
• Importance of flora
• Member of the normal flora
• Role of the resident flora
• Beneficial functions of normal flora
• Conclusion

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 Definition of commensal flora
• Normal flora: population of microorganisms that inhabit
skin and mucous membranes of healthy normal persons.
• Individual: a particular spectrum and strain
• Commensal bacteria  living in perfect harmony with
man without causing damage
• Goal of any organism: grow, thrive and produce
• Fast and efficient division  survival
• The most virulent pathogen may be less well adapted to
survive.
• Most suitable  pathogens (according opportunity)
 Definition of commensal flora (cont.)

• Normal flora  all microorganisms commonly

found on the surface or inside the body of
healthy individuals
• Normal flora and pathogenic flora  unclear
Example meningococcal or pneumococcal 
pneumonia and meningitis or sepsis but 10%
healthy carrier (the throat)
 Part of the body colonized by flora
• Skin: moist surfaces (groin, between the toes)
• Respiratory tract: nose, pharynx
• Digestive tract: mouth and large intestine
• Urinary tract: anterior part of the urethra
• Genital tract: vagina
• Other parts of the respiratory and digestive tract,
bladder and uterus: small qty bacteria (transient
way)
– Presence of bacteria  highly evocative pathological
 Part of the body colonized by flora
(cont.)

• Normally sterile organs: blood, CSF, synovial

fluid and deep tissue
• Gingival pockets around the teeth: 3 times>
bacteria in the stool
• Skin, mouth, vagina ≈ 106-107 bac/ml or /g
 Persistence of microorganism in the body

• Resist defense mechanism.

• Succeed in competition with other bacteria
– Example at mouth
• Large flow of saliva: adhesion to teeth and mucous
• Antibacterial compounds in saliva: enzyme, antibody …
• Acid metabolism of sugars by bacteria existing at this
level  kill other bacterias
 Persistence of microorganism in the body
(cont.)

• Fibronectin: adhesion protein promoting

colonization of Gram +.
• Fibronectin  selection of bacteria in mouth and
pharynx
• Example: inpatient  fibronectin deficient 
Gram- supplanted  high incidence pneumonia
Gram-
• Bacteria resistant defense mechanism 
colonization.
Persistence of microorganism in the body
(cont.)
 Preference for a particular site
• Bacteria with tropism > tissue (single tissue for
virus)
• Some being pathogenic for a specific organ
(choleric vibrio  small intestine)
• Tissue tropism: tissue property (depending on
the receiving tissue for pathogens)
– Mucous cell urinary  E coli
– Fibronectin  Gram +
 Preference for a particular site (cont.)

• New therapeutic form  neutralization of

tissue receptors
• Temperature and ventilation influence on
bacterial tropism
– Anaerobic bacterium  not present on the skin
– Treponema pallidum (syphilis)  sensitive high To
 Source of contamination
• Normal flora  infection opportunism
• Commensal microorganism organ  pathogenic
to other
– Ex 1: Staph in the nose or skin  abscess deep tissue
(brain, heart ...)
– Ex 2: E. coli in the gastrointestinal tract UTI
• More often infection given by the normal flora >
exogenous agent
• When circumstances allow any germs multiply in
the body  cause infectious disease
 Importance of flora
• Immunological stimulation
• Protection against pathogens
– The first occupation
– Production of growth-inhibiting substance other
(bacteriocins are lethal protein for other germs)
– Colonization by new strain  rare
 Importance of flora (cont.)
• Destruction of flora by ATB  endo and
exogenous pathogenic strain
– Number of Salmonella million times decreased by
treatment with Streptomycin
– Diarrhea by yeast or staph (effective treatment by
ATB in the intestine)
– Pseudo membranous colitis by Clostridium difficile,
very small qty bacterium at normal flora
(Clindamycin treatment)
 Importance of flora (cont.)
• Food and human metabolism
– Synthesis of nutrients in the colon
– Ex: synthesis of Vit K by E coli and bacteroide sp,
absorption
– Metabolism of several compounds cléf
• Ex: Stréroïdes hormones and bile salts secreted as
conjugated as glucuronide and sulfate  resorbed after
deconjugation by glucuronidase and sulfatase of flora
• Sometimes trasformation of chemical carcinogen
substance (eg sulphate cyclohexylamine cyclohexylamine,
carcinogenic cycloexamine eliminated by the urine)
 Member of the normal flora
• Viruses, protozoa, worms and bacteria
(bacteria more numerous than other)
• Anaerobes at least 1000 times > as many than
other
• 400 bacterial species presented in an
individual
 Member of the normal flora (cont.)

Germs mentioned even in low frequency but representative less qty

 Role of the resident flora
• Resident flora of certain areas plays a definite role in
maintaining health and normal function.
• Members of the resident flora in the intestinal tract
synthesize vitamin K and aid in the absorption of nutrients.
• On mucous membranes and skin, the resident flora may
prevent colonization by pathogens and possible disease
through “bacterial interference.”
• Members of the normal flora may themselves produce
disease under certain circumstances.
• They may produce disease if introduced into foreign locations
in large numbers and if predisposing factors are present.
 Role of the resident flora (cont.)
• Skin and mucous membranes always harbor a variety
of microorganisms that can be arranged into 2 groups:
– Resident flora consists of relatively fixed types of
microorganisms regularly found in a given area at a given
age; if disturbed, it promptly reestablishes itself.
– Transient flora consists of nonpathogenic or potentially
pathogenic microorganisms that inhabit the skin or mucous
membranes for hours, days, or weeks; it is derived from the
environment, does not produce disease, and does not
establish itself permanently on the surface.
 Role of the resident flora (cont.)
• Even using advanced molecular techniques, it is
difficult to define the human microbiome because
microbial species present vary from individual to
individual as a result of
– physiologic differences
– Diet
– age
– geographic habitat.
 Role of the resident flora (cont.)
Clinical problems caused by normal flora arise in the following ways:
1) The organisms are displaced from their normal site in the body to an abnormal site.
Example: the introduction of the normal skin bacterium, S. epidermidis, into the
bloodstream where it can colonize catheters and heart valves, resulting in bacterial
endocarditis.
2) Potential pathogens gain a competitive advantage due to diminished populations of
harmless competitors.
Example: when normal bowel flora are depleted by antibiotic therapy leading to
overgrowth by the resistant Clostridium difficile, which can cause severe colitis.
3) Harmless, commonly ingested food substances are converted into carcinogenic
derivatives by bacteria in the colon.
Example: the conversion by bacterial sulfatases of the sweetener cyclamate into the
bladder carcinogen cyclohexamine.
4) When individuals are immunocompromised, normal flora can overgrowand become
pathogenic or normal flora is carried by a healthy individual and passed
to other individuals which causes disease.
Example: Typhoid fever can be acquired from a carrier.
Beneficial functions of normal flora
Normal flora can provide some definite benefits to the host.
• First, the sheer number of harmless bacteria in the lower
bowel and mouth make it unlikely that, in a healthy person,
an invading pathogen could compete for nutrients and
receptor sites.
• Second, some bacteria of the bowel produce antimicrobial
substances to which the producers themselves are not
susceptible.
• Third, bacterial colonization of a newborn infant acts as a
powerful stimulus for the development of the immune
system.
• Fourth, bacteria of the gut provide important nutrients, such
as vitamin K, and aid in digestion and absorption of nutrients.
 Conclusion
• Role of flora in health and disease
– Immune system stimulation
– Protection against pathogens
– Biomass: food and metabolism
• Negative points
– Pathogenic opportunist
– Synthesis of carcinogen
 Refereneces
Jawetz, Melnick, & Adelberg’s. Medical Microbiology. 2007. 24
edition.

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