Microbiology

Topic: Classification of Medically

Important Bacteria &
The Human Microbiome
By: Muhammad Zubair (Rankers Coaching Classes)
• Normal flora are those microorganisms that are the permanent
residents of the body in all humans.
• The microbiome refers to normal flora organisms and additionally
includes the genetic composition and capabilities of these organisms.
• Some people can be transiently colonized, either for short or long
periods, with certain organisms, but those are not considered
members of the normal flora.
• Carriers (also called chronic carriers) are individuals in whom
pathogenic organisms are present in significant numbers and
therefore are a source of infection for others.
• Normal flora organisms inhabit the body surfaces exposed to the
environment, such as the skin, oropharynx, intestinal tract, and
vagina. Members of the normal flora differ in number and kind at
various anatomic sites.
• Members of the normal flora are low-virulence organisms. In their
usual anatomic site, they are nonpathogenic. However, if they leave
their usual anatomic site, especially in an immunocompromised
individual, they can cause disease. Normal flora organisms can also
horizontally acquire genes from other members of the microflora,
which can impact their virulence.
• Colonization resistance occurs when members of the normal flora
occupy receptor sites on the skin and mucosal surfaces, thereby
preventing pathogens from binding to those receptors.
Important Members of the Normal
Flora
• Skin. The predominant member of the normal flora of the skin is S.
epidermidis. It is an important cause of infections of prosthetic heart
valves and prosthetic joints.
• C. albicans, a yeast also found on the skin, can enter the bloodstream
and cause disseminated infections, such as endocarditis in
intravenous drug users.
• S. aureus is also present on the skin, but its main site is in the nose. It
causes abscesses in the skin and in many other organs.
• Oropharynx. The main members of the normal flora of the mouth
and throat are the viridans streptococci, such as S. sanguinis and S.
mutans.
• Viridans streptococci are the most common cause of subacute
endocarditis.
• Gastrointestinal tract. The stomach contains very few organisms
because of the low pH.
• The colon contains the largest number of normal flora and the most
diverse species, including both anaerobic and facultative bacteria.
There are both gram-positive and gram-negative rods and cocci. The
members of the colonic normal flora are an important cause of
disease outside of the colon.
• The two most important members of the colonic flora that cause
disease are the anaerobe B. fragilis and the facultative E. coli. E.
faecalis, a facultative bacterium, is also an important pathogen.
• Vagina. Lactobacilli are the predominant normal flora organisms in
the vagina.
• They keep the pH of the vagina low, which inhibits the growth of
organisms such as C. albicans, an important cause of vaginitis.
• Urethra. The outer third of the urethra contains a mixture of bacteria,
primarily S. epidermidis.
• The female urethra can become colonized with fecal flora such as E.
coli, which predisposes to urinary tract infections.
SELF-ASSESSMENT QUESTION
An outbreak of postsurgical wound infections caused by S. aureus has
occurred in the hospital. The infection control team was asked to determine
whether the organism could be carried by one of the operating room
personnel. Using your knowledge of normal flora, which of the following
body sites is the most likely location for this organism?
(A) Colon
(B) Gingival crevice
(C) Mouth
(D) Nose
(E) Throat
Gram Staining:
• This staining procedure, developed in 1884 by the Danish physician
Christian Gram, is the most important staining procedure in
microbiology.
• It separates most bacteria into two groups: the gram-positive
bacteria, which stain purple, and the gram-negative bacteria, which
stain red.
• The Gram stain involves the following four-step procedure:
(1) The crystal violet dye stains all cells purple.
(2) The iodine solution (a mordant) is added to form a crystal violet–
iodine complex; all cells continue to appear purple.
(3) The organic solvent, such as acetone or ethanol, extracts the purple
dye complex from the lipid-rich, thin-walled, gram-negative bacteria to
a greater degree than from the lipid-poor, thick-walled, gram-positive
bacteria. The gram-negative organisms appear colorless; the gram-
positive bacteria remain purple.
(4) The red dye safranin stains the decolorized gram-negative cells
red/pink; the gram-positive bacteria remain purple.
The Gram stain is useful in two ways:
(1) In the identification of many bacteria.
(2) In influencing the choice of antibiotic because, in general, gram-
positive bacteria are more susceptible to penicillin G than are gram-
negative bacteria.
• However, not all bacteria can be seen in the Gram stain.
• Note that it takes approximately 100,000 bacteria/mL to see 1
bacterium per microscopic field using the oil immersion (100×) lens.
So the sensitivity of the Gram stain procedure is low.
• This explains why a patient’s blood is rarely stained immediately but
rather is incubated in blood cultures overnight to allow the bacteria
to multiply
• One important exception to this is meningococcemia in which very
high concentrations of Neisseria meningitidis can occur in the blood.