Normal flora

Normal flora This term describes the various micro-organisms usually bacteria and fungi that permanently inhabit the body. They are found on the skin, mucosae, and in the various bodily tracts. Viruses and parasites are not normal florae. They are acquired at the first contact with the animate and inanimate world usually at the time when membranes rupture at child birth. The microbes can also migrate through the maternal genital tract into the uterus. The GIT is colonized as the baby comes into contact with the parents, food and the environment. Internal organs like CNS, blood, lower bronchi, alveoli, liver, spleen, kidneys and urinary bladder are usually free of all but occasional transient flora. Carrier state. This implies that an individual is harboring a potentially pathogenic microbe and thus a potential source of infections to others. But, the individual doesnt have signs and symptoms of the disease. In other cases the individual has recovered from an illness but continues shedding the infectious organisms. Colonisation . This is the acquisition of new organisms. It usually involves the attachment and multiplication of infectious organisms to mucous membranes. colonisation is an important step in the pathogenesis of infections. Transient flora. These are microbes that exist on the body usually the skin but do not multiply from there. The number of transient flora is determined by the hygiene of an individual. In contrast, resident flora grows and multiplies on the skin and may invade deeper skin layers.

The role of normal flora

They cause disease (opportunistic infections) especially in Immunocompromised or debilitated individuals. Normal flora is usually harmless at their normal site but become pathogenic upon invasion of other sites. E.g Streptococcus viridans is normally non-pathogenic in the mouth but upon invasion of heart valves can cause infective endocarditis. Candida albicans is a normal GIT flora but can cause systemic infection in Immunocompromised individuals. They constitute a protective host defense mechanism by occupying sites on the skin and mucous membranes thus interfering with the colonisation by pathogenic bacteria. This is through competing with pathogenic organisms for nutrients and receptors. If normal flora is suppressed, pathogenic flora grow and multiply causing disease. E.g Long term use of broad spectrum antibiotics like Clindamycin and vancomycin that suppress normal flora of the colon is associated with a Clostridium difficile infection called antibiotic associated diarrhea and Pseudomembranous colitis. Normal flora produce several B vitamins and Vitamin K, important for a healthy body functioning thus, long term use of antibiotics, and GIT surgery may result in a reduction of normal flora and lead to vitamin defencies. These may present as bleeding disorders and anaemia.

Dr.KTH, Normal flora

Normal flora of the skin1 The predominant organism is staphylococcus epidermidis (103-104/cm3 of skin). Its none pathogenic on the skin but causes infection of prosthetic valves and damaged heart valves. Other organisms on the skin include; Propionibacterium acnes, Corynebacterium spp, Pseudomonas aeruginosa, Staphylococcus epidermidis and Candida albicans. Most of the organisms are found in the stratum corneum and some in the hair follicles were it acts as a reservoir to replenish the superficial flora after hand washing. Propionibacterium acnes and Peptococcus are found deeper in the follicles where the Oxygen tension is low. Normal flora of the respiratory tract The nose, throat and mouth are colonized by a no. of micro-organisms. On the contrary, the lower bronchi and alveoli are sterile. The nose is colonized by Streptococcal and Staphylococcal species e.g MRSA. The throat contains Streptococcal viridans, Neisseria spps and S.epidermidis. These organisms occupy sites on the pharyngeal mucosa thus inhibiting the growth of pathogenic Streptococcus pyogenes, Neisseria meningitis and S.aureus Normal flora of the intestinal tract In the mouth, S.viridans is the commonest, but the most important is S.mutans which causes dental caries. The Viridans gp. is also the leading cause of Subacute bacterial endocarditis secondary to dental procedures. Other oral normal flora include-Eikenella corrodens transmitted through human bites Clenched-fist fights.It causes soft tissue infections. Bacteriodes, fusobacterium and Clostridium found in gingival crevices and transmitted through aspiration in debilitated patients cause lung abscesses. Gingival crevices are also the natural habitant for Actinomyces israelii which causes abscesses in the jaw, lungs and abdomen.

The stomach contains few organisms because of its Low PH and enzymes. It mainly contains H.pylori asscd with PUD, chronic gastric ulcers, Ca Stomach. The small intestines contain a few Streptococci, Lactobacilli and yeasts especially Candida albicans The colon is a major location of bacteria and contains about 1011organisms/g of feaces. It contains organisms like Bacteriodes, Bifidobacterium, Eubacterium, Coliforms, Enterococcus, Lactobacillus, and Clostridium.

The normal flora of the intestinal tract plays a significant role in extra intestinal dse - Escheria coli causes UTI - Bacteriodes fragilis causes peritonitis - Enterococcus feacalis causes UTI and endocarditis
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Dr.KTH Normal flora

Dr.KTH, Normal flora

Pseudomonas aeruginosa causes wound infections

Normal flora of the genital-urinary tract Vaginal flora changes with age. In children, upper respiratory tract organisms like Haemophillus and Streptococcus are predominant whereas in adults its Lactobacillus spps. Lactobacillus produces acid which lows the PH is an adult womans vagina. This prevents the overgrowth of potential pathogens like Candida albicans, and Gardnella vaginalis . Fecal flora may also colonise the vagina resulting in recurrent UTI from organisms like E.coli and Enterococcus. The vagina may also be colonized by GpB Streptococcus e.g Streptococcus agalactiae which may result in sepsis and meningitis in the new born.

Dr.KTH, Normal flora