Normal Flora Normal Flora Normal Flora Definition Normal

Normal Flora Normal Flora Normal Flora  Definition Normal

Normal Flora Normal Flora Normal Flora Definition Normal flora is the mixture of microorganisms (bacteria and fungi)

that are regularly found at any anatomical site of human body like: Normal Flora

Skin Eyes (i.e.Cunjunctiva) Nose (i.e. Respiratory tract) Mouth (i.e Human Oral

Cavity) Ears Urogenetal tract Elementry tract Normal Flora Resident flora Acquired rapidly during & after birth

Normal Flora Resident flora Reflects age of person Normal Flora Resident flora Changes continuously through out life .

Normal Flora Resident flora Reflects nutrition of person Normal Flora Resident flora Reflects genetics of person

Normal Flora Resident flora 90% is S. epidermidis; S. aureus, may be in moist areas Normal Flora Resident flora Reflects environment

of person Normal Flora Resident flora Reflects sex of person Normal Flora Sterile tissues In a healthy human, the internal tissues such as:

blood brain muscle cerbrospinal fluid (csf.) are normally free of microorganisms. Importance of The Normal Flora (Advantages) 1. They constitute a

protective host defense mechanism by occupying ecological niches. Importance of The Normal Flora (Advantages) 2. They produce vitamin B and vitamin K in intestine.

Importance of The Normal Flora (Advantages) 3. The oral flora contribute to immunity by inducing low levels of circulating and secretory antibodies that may cross react

with pathogens. Importance of The Normal Flora (Advantages) 4. The oral bacteria flora exert microbial antagonism against nonindigenous species by production of inhibitory fatty acids, peroxides,

bacteriocins, etc. Importance of The Normal Flora (Advantages) 5. The normal flora may antagonize other bacteria through the production of substances which inhibit or kill nonindigenous species.

Importance of The Normal Flora (Disadvantages) 1. They can cause disease in the following: a) When individuals become immunocompromised or debilitated. b) When they change

their usual anatomic location. Importance of The Normal Flora 2. The oral flora of humans may harm their host since some of these bacteria are pathogens or opportunistic pathogens

Estimation of the Normal flora It has been calculated that the normal flora human body about 1012 bacteria on the skin, 1010 in the mouth, and 1014 in the . gastrointestinal tract Normal Flora of the Skin The most important

sites are: 1. Axilla 2. Groin 3. Areas between the toes Normal Flora of the Skin The majority of skin microorganisms are found in the most

superficial layers of the epidermis and the upper parts of the hair follicles. Normal Flora of the Skin Important bacteria: 1. Staphylococcus epidermidis 2. Micrococcus sp.

3. Corynebacteria sp. 4. Mycobacterium smegmatis Normal Flora of the Conjunctiva 1. Staphylococcus epidermidis 2. Corynebacterium sp. 3. Propoinibacteriumacnes) 4. Staphylococcus aureus

5. Viridans streptococci 6. Neisseria sp. 7. Haemophilus influenzae Pathogens which do infect the conjunctiva Neisseria onorrhoeae Chlamydia trachomatis Normal Flora of the Respiratory

Tract A) The nares (nostrils) 1. Staphylococcus epidermidis 2. Corynebacteria 3. Staphylococcus aureus 4. Neisseria sp. 5. Haemophilus sp 6. Streptococcus pneumoniae

Normal Flora of the Respiratory Tract B) The upper respiratory tract (nasopharynx). 1. Non-hemolytic streptococci 2. Alpha-hemolytic streptococci 3. Neisseria sp.

4. Streptococcus pneumoniae 5. Streptococcus pyogenes 6. Haemophilus influenzae 7. Neisseria meningitidis Normal Flora of the Respiratory Tract C) The lower respiratory tract (trachea, bronchi, and

pulmonary tissues): Usually sterile. The individual may become susceptible to infection by pathogens descending from the nasopharynx e.g. H. influenzae S. pneumoniae). Normal Flora of the Human Oral

Cavity 1. 2. 3. 4. 5. 6. 7. 8.

Oral bacteria include: Viridans streptococci Lactobacilli Staphylococci (S. aureus and S. epidermidis) Corynebacterium sp. Bacteroides sp. Streptococcus sanguis (dental plaque)

Streptococcus mutans (dental plaque) Actinomyces sp. The Normal Flora of The Ears (i.e. external ear) The external ears contains avariety of microorganisms. These include: 1. Staphylococcus epidermidis

2. Staphylococcus aureus 3. Corynebacterium sp Normal flora of the Urogenital Tract a) The anterior urethra 1. Staphylococcus epidermidis 2. Enterococcus faecalis 3. lpha-hemolytic streptococci. 4. Some enteric bacteria (e.g. E.

coli, Proteus sp.) 5. Corynebacteria sp. 6. Acinetobacter sp. 7. Mycoplasma sp. 8. Candida sp. 9. Mycobacterium smegmatis Normal flora of the Urogenital Tract b) The vagina

1. Corynebacterium sp. 2. Staphylococci 3. Nonpyogenic streptococci 4. Escherichia coli 5. Lactobacillus acidophilus 6. Flavobacterium sp. 7. Clostridium sp. 8. Viridans streptococci 9. Other Enterobacteria

Normal Flora of the Gastrointestinal Tract (GIT) In humans, the GIT flora are influenced by: 1. Age 2. Diet 3. Cultural conditions 4. The use of antibiotics

Normal Flora of the Gastrointestinal Tract (GIT) At birth The entire intestinal tract is sterile, but bacteria enter with the first feed. The initial colonizing bacteria vary with the food source of the infant.

Normal Flora of the Gastrointestinal Tract (GIT) In breast-fed 1. Bifidobacteria account for more than 90% of the total intestinal bacteria. 2. Enterobacteriaceae 3. Enterococci 4. Bacteroides

5. Staphylococci 6. Lactobacilli 7. Clostridia Normal Flora of the Gastrointestinal Tract (GIT) 1.

2. 3. 4. 5. In bottle-fed infants Bifidobacteria are not predominant. When breast-fed infants are switched to a diet of cow's milk or solid food,

bifidobacteria are progressively joined by: Enterics Bacteroides Enterococci Lactobacilli Clostridia Normal Flora of the Gastrointestinal Tract (GIT)

In the upper GIT of adult humans mainly acid-tolerant lactobacilli e.g. Helicobacter pylori Normal Flora of the Gastrointestinal Tract (GIT) The proximal small intestine

1. Lactobacilli 2. Enterococcus faecalis 3. Coliforms 4. Bacteroides Bacterial-human relationships Normal flora Opportunistic infections Pathogenic infections

Normal flora - Risks Dental plaque Dental caries: destruction of enamel, dentin or cementum of teeth Periodontal disease Inflammatory bowel disease

Obesity Opportunistic flora Some normal flora become opportunistic pathogens Staphylococcus aureus, Streptococcus mutans,( Enterococcus faecalis, Streptococcus pneumoniae, .)Pseudomonas aeruginosa, etc Breach of skin/mucosal barrier: trauma,

surgery, burns Bacterium at one site may be commensal, but might be pathogenic at another site Mouth flora Opportunistic flora Growth of commensals may put patient at risk Broad-spectrum antibiotic therapy decreases total number of bacterial in gut

During repopulation, faster-growing aerobic Enterobacteriaceae over slower-replicating anaerobes increases probability of gram-negative bacteremia Cross-reactive responses to host tissue: Superantigen Chronic, low-grade inflammation Perturbation of cytokine network Gastrointestinal flora Antibiotics overuse Antibiotic associated

diarrhae C. dfficile -associated diarrhea (CDAD) Pseudomembranous colitis toxic megacolon

The flora of the large intestine (colon) 1. 2. 3. 4. 5. Enterococci

Clostridia lactobacilli Bacteroides Bifidobacterium (Bifidobacterium bifidum) 6. Escherichia coli 7. Methanogenic bacteria 8. Viridans streptococci 9. Staphylococcus sp. 10. Proteus sp.

11.Candida albicans (Yeast) 12. Mycoplama sp. Normal flora - Risks and Opportunistic Clinical conditions that may be caused by members of the normal flora Probiotics/Prebiotics Probiotic

Oral administration of living organisms to promote health Mechanism speculative: competition with other bacteria; stimulation of nonspecific immunity Species specific: adherence and growth (tropism) Prebiotic Non-digestible food that stimulates growth or activity of GI microbiota, especially bifidobacteria and lactobacillus bacteria (both of which are noninflammatory) Typically a carbohydrate: soluble fiber

Gnotobiology Gnotobiotic animals: germfree (axenic) Fetus is sterile Cesarean sections to obtain fetus Fetus growing in sterile isolator Not anatomically or physiologically normal Poorly developed lymphoid system, thin intestinal wall, enlarged cecum, low antibody titers Die of intestinal atonia ( motility problem)

Require vitamin K and B complexes No dental caries or plaque More susceptible to pathogens Probiotics/Prebiotics Probiotic Oral administration of living organisms to promote health Mechanism speculative: competition with other bacteria; stimulation of nonspecific immunity Species specific: adherence and growth (tropism)

Prebiotic Non-digestible food that stimulates growth or activity of GI microbiota, especially bifidobacteria and lactobacillus bacteria (both of which are noninflammatory) Typically a carbohydrate: soluble fiber Gnotobiology Gnotobiotic animals: germfree (axenic) Fetus is sterile

Cesarean sections to obtain fetus Fetus growing in sterile isolator Not anatomically or physiologically normal Poorly developed lymphoid system, thin intestinal wall, enlarged cecum, low antibody titers Die of intestinal atonia ( motility problem) Require vitamin K and B complexes No dental caries or plaque More susceptible to pathogens

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