Normal & Abnormal Gut Flora

Learning Outcomes

definitions : normal flora, commensal body sites & types of microbiota role of normal flora opportunistic infections by normal flora concept of pre-biotics & probiotics

Microbial flora of the Gut

normal

& abnormal effects on the host host defences

Definitions

normal

flora transient flora commensal

Role of Normal Flora

state

of delicate balance in health healthy competition

food space

biological

defence

Commensals as Opportunistic Pathogens

balance

is upset entry into sterile tissues lowered host defence

Normal flora & the Gut

variation
mouth oesophagus stomach small

in flora composition & density

bowel large bowel

Normal flora composition

oral
very

wide variety

stomach
lactobacilli,

acidophilic streptococci

small & large intestine

anaerobes; coliforms

spore-formers

Host Defences of the Gut

mouth
normal

flora swallowing & drinking antibacterial substances

saliva, lysozyme, lactoperoxidase, IgA

Host Defences of the Gut

oesophagus
firect

flow of fluids downwards peristalsis

stomach
high

acidity (very low pH) mucous

Host Defences of the Gut

small

intestine

normal

flora peristalsis secretory IgA, lymphoid tissue mucus epithelial shedding

Host Defences of the Gut

large

intestine

normal

flora peristalsis mucus shedding of epithelium

Normal Flora & Gut Diseases

commensal-commensal

balance is upset host-commensal balance is upset reduced host mechanisms

GI diseases due to abnormal gut flora

oral

infections gastritis / gastric ulcers intestinal ulcers / necrosis cholangitis peritonitis chronic diarrhoea

Peridontal Diseases

gingivitis & peridontitis gingival crevise

space between gum & tooth margin contains lots of normal flora; 75% anaerobes (acinomycetes, lactobacilli, actinobacillus) may enlarge to serve as pockets for bacteria infection (gingivitis & peridontitis) & halitosis (bad breath) gum recedes

tooth loosening tooth loss

Necrotizing Gingivitis

Acute necrotizing ulcerative gingivitis or Vincents angina

Fusiform bacilli rods with pointed ends

Borellia vincenti, etc. spirochaetes

Dental caries

Dental plaque
microbes

living as a thin film on teeth (streptococci esp. Strept. mutans) removed by brushing but re-establishes itself
Strept.

mutans forms polysaccharide matrix on teeth surface; allows other bacteria to live plaque becomes thicker if regular brushing is not done

Dental caries

Tooth decay
microbes

in dental plague use dietary sugar lactic acid produced decalcifies (demineralization of) tooth enamel other bacteria produce proteolytic enzymes further breakdown of organic components of tooth dental cavity (caries)

Actinomycosis
Actinomyces

Complication of gingivitis or dental caries A. israelii; A. propionica Actinomyces also infects other organs penicillin

Broad Spectrum Antibiotics

remember

broad spectrum?? oral candidiasis Staph. aureus enterocolitis proliferation of staphylococci production of toxins, etc.

Oral candidiasis

Candida albicans Broad spectrum antibiotics; immunosuppression or immunodeficiency imbalance of oral flora Topical antifungal agents (e.g. nyastatin)

Helicobacter pylori & gastritis

H. pylori Gm-neg. spiral bacteria 70-80% gastric ulcers; 90% duodenal ulcers dyspepsia Diagnosis

histology

of biopsy urea breath test

H. pylori diagnosis & treatment

Diagnosis
histology

of biopsy urea breath test

Treatment
proton

pump inhibitor (omeprazole) 2 antibiotics amoxicillin + clarithromycin

Broad Spectrum Antibiotics & opportunistic intestinal infections

clindamycin (effective against staphylococcus & Bacteroides infections) Clostridium difficile (nf proliferates) produces cytotoxin, enterotoxin, other toxins pseudomembraneous colitis What are the symptoms?

Pseudomembraneous colitis
stool

specimen isolation in large numbers toxin detection (EIA)

Opportunistic Infections of Structures Adjacent to the Gut

entry

into sterile sites

biliary

tract abdominal cavity

Biliary Tract Infections

gallstone obstruction stasis enterobacteria (coliforms), anaerobic bacteria, streptococci

Biliary Tract Infection

cholangitis
bacterial

infection of bile lumen

liver abscess
developing

countries - parasitic e.g. amoebic developed countries bacterial or fungal

Treatment of Biliary Tract Infection

depending on condition most are mixed aetiology

cholangitis

combination antibiotic therapy

e.g.

beta-lactam antibiotics + metronidazole + aminoglycoside

Peritonitis & Intra-Abdominal Sepsis

trauma (injury & surgery) perforation of gut wall mixed aetiology

Bacteroides

fragilis, enterobacteria, anaerobic

streptococci

Peritonitis & Intra-Abdominal Sepsis

mixed aetiology combination antibiotic therapy

enterobacteria

= gentamicin streptococci = ampicillin or cephalosporin bacteroides = metronidazole

single aetiology is uncommon inadequate treatment leads to septicaemia

Chronic Diarrhoea
opportunistic

infections low pathogenic organisms AIDS patients

Cryptosporidium parvum
protozoon

parasite wide spread in many animals chronic diarrhoea in AIDS (wasting) may be life threatening spiramycin, a macrolide
Crypt. parvum oocysts acid fast stain

Blastocystis hominis
protozoon

parasite wide spread in many animals, including man chronic diarrhoea in AIDS (wasting)
Blastocystis oocysts acid fast stain

Probiotics & Prebiotics

Probiotics

= Live microorganisms which when = Non-digestible food ingredients that

administered in adequate amounts confer a health benefit on the host (WHO).

Prebiotics

selectively stimulate growth of one or a limited number of probiotic bacteria, thus improving host health.

Probiotics
beneficial bacteria Lactobacillus and Bifidobacterium strains taken as food supplement

Probiotics Benefits

composition important improve general well being Improve immune system Increases NK cell numbers Beneficial for infantile eczema Highly beneficial for anti-biotic induced diarrhoea, travellers diarrhoea, entero-colitis ? Others

Prebiotics
nutrient for probiotics non-digestible carbohydrates (e.g. oligosaccharides), includes fibres

Remember
opportunistic
mainly

GI infections are :

of mixed aetiology as the source is endogenous gut flora combination therapy is the rule
Thank

you; any questions?