MICROBIOLOGY

Normal Flora, Bacteria and Disease

Dr. Santos, Camilo
NORMAL FLORA Association between 2 or more species living
Study of the relationships between SYMBIOSIS together
MICROBIAL ECOLOGY
microorganisms and their environment It encompasses a spectrum of relationships
- Now referred to as normal microbiota or
commensals
- Population of microorganisms that inhabits the
skin and mucous membrane of a normal healthy
NORMAL OR individual
INDIGENOUS FLORA - These are microbes normally found on or in the
human body without causing disease
- 2 types of flora:
1. Resident Flora
2. Transient Flora
Normal Flora- A Friend or A Foe
 It becomes a foe when there is bridge in the defenses of the body
or when the individual becomes immunocompromised, then they
are susceptible to be infected by their own normal flora. The
normal flora will become an opportunistic infection.
Three Types of Symbiotic Relationship:
Transient Flora
 Mutualism- both members benefit
 Microorganism inhabiting a body surface or cavity for a brief
 Commensalism- other member not harmed, commensal benefits
period of time or unable to remain in the body for extended
 Parasitism- parasite benefits; host is harmed
periods of time due to:
1. Difficulty competing with established resident flora or
microbes
2. Elimination by the body’s immune system
3. Physical or chemical changes within the body that
discourage the growth of transient microbes
Additional Notes:
 Transient flora can still harm the individual when the person
becomes immunocompromised.
 Displacement of the normal flora into other areas, that’s the time
they can cause infection and result to having a disease. Example:
Escherichia Coli normally found in the intestines invading the
urinary tracts will cause infection

Beneficial Effects of Normal Flora:

1. Priming the immune system-stimulating non-specific immune
responsiveness
 It is shown that animals placed in sterile environment soon
after birth has little immunity and easily succumb when
transferred to non-sterile environment
2. Intestinal flora- Vit. K and B complex synthesis
3. Defense against microbial pathogens- accomplished by:
a. Stimulating nonspecific immune responsiveness
b. Interfere with the establishment of populations of
pathogenic microorganisms
o Bifidobacteria lower the pH to 5
o Vaginal bacteria (lactobacillus) provides protection
Picture above: against gonococcal vulvovaginitis
o Prolonged oral antibiotic treatment alters the flora
 Here are some of the different normal flora of your body:
of the GIT
Bifidobacteria, Escherichia Coli, and Lactobacilli. These good
 Candida causes diarrhea and superficial
bacterial flora continuously release small antigens which
infection
stimulates our body’s immune system making it more stronger.
 S. aureus causes nercrotizing enterocolitis
 Remember that your organisms, they share common antigens
 C. difficile causes pseudomembranous colitis
especially in your GIT. Most of your normal flora in your GIT are
gram negative enterobacteriaceae
 The pathogenic floras are the Campylobacter, Enterococcus
faecalis and Clostridium difficile.

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
Function of Normal Flora: Factors that Determine Composition of Microbial Flora continued….
It blocks exogenous colonization by pathogens by variety of mechanisms 3. pH at the site
called bacterial interference. It has been attributed to: o Flora of female genital tract- survive in vaginal pH of 4.0-5.9
1. Production of bacteriocins (women of child-bearing age)
2. Maintenance of an inhospitable environment o Human milk with high lactose concentration → pH of 5.0-5.5
3. Colonization resistance: → support growth of Bifidobacterium spp.
 Occurs when members of normal flora occupy receptor sites o Areas of the body with low redox potential → support only
on the skin and mucosal surfaces, preventing pathogens organisms capable of fermentation (e.g. Bacteriodes,
from binding to receptors Fusobacterium)
4. Generation of toxic metabolic products by the flora 4. Intake of antibiotics, age, nutritional, and immune status of the
5. Competition between the pathogens’ and flora’s components for host
limiting nutrients o Diabetics and alcoholics – prone to colonization by gram-
negative rods
ADVANTAGES: o Antibiotic intake → suppress normal flora → opportunistic
1. The normal flora evokes antibody production. These antibodies infection
cross react with pathogens having related or shared antigens,
thus raising the immune status of the host against the invading MEDICALLY IMPORTANT MEMBERS OF THE NORMAL FLORA
pathogen
2. Colonies produced by some organisms of the normal flora have
harmful effects on the pathogens
3. Endotoxins liberated by the normal flora may help the defense
mechanism of the body.
DISADVANTAGES:
1. They become pathogenic when the immunity is lowered
2. They may act as pathogens in different tissue (other than their
normal habitat) E.g. normal flora of intestine may cause urinary
tract infection (UTI)

NORMAL FLORA OF THE DIFFERENT SITES:

 Skin
o Most abundant in moist areas (armpit, groin, perineum)
o Usually on most superficial layers of cells and upper part of hair
follicles
o Composition depends on activity of sebaceous or sweat glands
a. Aerobic and anaerobic diphtheroid, Corynebacterium,
Propionibacterium- moist areas such as axillae and
between toes
b. Non-hemolytic aerobic and anaerobic staphylococci-
Staphylococcus epidermidis, Peptostreptococcus
c. Alpha-hemolytic streptococci and enterococci-
Streptococcus viridans, Streptococcus faecalis
d. Gram negative coliform bacilli and Acinetobacter
Origin of Normal Flora e. Fungi and yeast
 Fetus is in a sterile environment until birth  Pityrosporum ovale, Pityrosporum orbiculare,
 At birth, exposed to organism via the following: Torulopsis glabrata, Candida albicans (common)
a. Passage through the birth canal f. Nonpathogenic mycobacteria
b. Individuals handling the infant at birth o Factors that eliminate nonresident microorganism from the skin:
c. Environment  Fatty acids in sebaceous secretions
 As infant grows, microbial flora eventually becomes similar to  Presence of lysozyme
those of older individuals  Acid pH of the skin because of the sweat
Factors that Determine Composition of Microflora:  Constant sloughing of the outermost layer of the skin
1. Amount and type of nutrients at the site  Mouth and Respiratory Tract
o Propionibacterium acnes- able to breakdown skin lipids to o Mouth
fatty acids → colonize ducts of hair follicles 1. Tongue and buccal mucosa- Viridans streptococci (S.
2. Ability to resist antibacterial effects of substances salivarius, S. sanguis, S. milleri), Neisseria spp., Moraxella
o Fatty acids & bile catarrhalis, occ. Candida albicans
2. Gingival crevices and tonsillar crypts- anaerobic flora:
Bacteriodes melaninogenicus, Treponemes, Fusobacteria,
Clostridia, Actinomyces, Peptostreptococcus

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
o Nose and Nasopharynx- similar to those found in mouth BACTERIA AND DISEASE
1. Common: Staphylococcus aureus, Staphylococcus Undesirable host-parasite relationship
epidermidis, Diphtheroid resulting in interruption in the normal
2. Transient carriage of S. pneumoniae, Hemophilus spp., and DISEASE functioning of a body structure
N. meningitides Condition that results in noticeable impairment
of body function.
 Oropharynx and Digestive Tract Invasion of the body by pathogenic
INFECTION
o Oropharynx microorganisms.
 Common: α-hemolytic and non-hemolytic streptococci, a. Acute Infection
diphtheroid, S. aureus, S. epidermidis, viridans streptococci,  Characterized by symptoms that have a rapid onset
Moraxella catarrhalis but last only for a short period of time
b. Chronic Infection
o Gastrointestinal tract  Infection that develops slowly and lasts for months or
1. Esophagus- transient mouth flora years (2 weeks and above)
2. Stomach- rapidly becomes sterile after meals; most Organisms that damage human host either by
organism destroyed by acid pH except parasites and PATHOGENS direct invasion and injury or by the production
Helicobacter pylori of harmful toxic products
3. Small intestine- scanty resident flora except in the lower PATHOGENECITY Ability to produce disease
ileum Degree of pathogenicity; measure of ability to
 In breastfed infants- 99% are anaerobic VIRULENCE
produce disease
(Bifidobacterium) Measure of virulence:
 In artificially fed infants- Lactobacillus acidophilus
 Minimum Lethal Dose (MLD)- smallest amount killing a specified
predominate
experimental animal of a given weight in a given period of time
4. Colon- more than 96-99% are anaerobes (Bacteroides,
 LD50- infectious dose killing 50% of the animal tested
anaerobic Lactobacilli, Clostridium, Fusobacteria, anaerobic
Establishment and growth of a microorganism
streptococci); 1-4% facultative coliforms COLONIZATION
on a body surface
Lipopolysaccharide (LPS) component of the
 Genito-Urinary Tract
outer membrane of gram (-) bacteria
o Urinary tract: sterile above the distal 1 cm of the urethra ENDOTOXIN
o Vagina
Lipid A- responsible for toxic properties of LPS
 Before puberty and postmenopausal stage: yeasts, gram-
negative bacilli, gram positive cocci A toxic protein (CHON) produced by a
EXOTOXIN
 During child-bearing years: lactobacilli, anaerobic gram- microorganism
negative bacilli, gram-positive cocci Hosts with weaknesses or defects in the Innate
IMMUNOCOMPROMISED
and Adaptive defenses
NORMALLY STERILE IN HEALTH Infection in which the infectious agent is
LATENT INFECTION
present but not active
Population of microorganisms routinely found
NORMAL FLORA growing on the body surfaces of healthy
individuals
A microbe or virus that cause disease only
OPPORTUNISTIC
when introduced into unusual location or into
INFECTION
an immunocompromised host
A microorganism or virus that is able to cause
PRIMARY PATHOGEN
disease in an otherwise healthy individual
VIRULENCE Attributes of microorganism or virus that
DETERMINANTS promote pathogenicity
KOCH’S POSTULATES:
1. The same organism must be found in all cases of a given disease
2. The organism must be isolated and grown in pure culture from the
infected person
3. The organism from the pure culture must reproduce the disease
when inoculated into a susceptible animal
4. The organism must be isolated in pure culture from the
experimentally-infected animal
 A single pathogen can cause several disease conditions
 A single disease condition can be caused by several different
microorganisms
 Infectious agent that satisfies Koch’s postulate is necessary but not
necessarily sufficient to cause a specific Illness

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
Exceptions of Koch’s Postulate: I. Contact Transmission
1. Microorganism must be found in abundance in all organisms A. Direct Contact Transmission
suffering from the disease, but should not be found in healthy - Person to person transmission. No intermediate object is
organisms involved
 Asymptomatic or Subclinical infection - Autoinoculation, sexual contact, airborne, thru infected
2. Microorganism must be isolated from a diseased organism and birth canal, skin to skin contact
grown in pure culture
 Viruses, M. leprae, others B. Indirect Contact Transmission
3. Cultured microorganism should cause disease when introduced into - Agent is transferred via a nonliving object
a healthy person - Towels, eating utensils, thermometers, stethoscopes,
 Specifies should NOT MUST. Depends on the state of bedding, clothes, money, syringes, animal borne, insect
immunity, vaccination, previous exposure, genetics borne, bites
4. Microorganism must be reisolated from the inoculated, diseased
experimental host and identified as being identical to the original C. Droplet Transmission
specific causative agent - Microbes are spread in mucus droplets that travel short
Is the study of the structural and functional distance (less than 1 meter) sneezing, coughing, talking and
PATHOLOGY laughing
manifestations of the disease
Evidence of disease that is experienced or
perceived
SYMPTOMS
Subjective changes in body functions noted by
patient but not apparent to the observer
Objective evidence of a disease the physician
SIGN
can observe and measure
A specific group of signs and symptoms that
SYNDROME
accompany a particular disease
Invasion and multiplication of microbes in an
INFECTION
individual or population
Is a disease caused by a microbe
INFECTIOUS DISEASE-
Disease is when the infection causes damage to
CONTAGIOUS
the individual’s vital functions and systems
A wider term covers genetic and other
diseases, often used beside Infectious disease
Undesirable host-parasite relationship
resulting in interruption in normal function of a
DISEASE
body structure

NOTE: An infection does not always result in

disease II. VEHICLE TRANSMISSION
A supply of pathogen/infection/disease  Transmission of disease via medium as water, food, blood, body
RESERVOIR fluids, and intravenous fluids
For example, female anopheles mosquito is a
reservoir of Plasmodium falciparum for malaria A. Waterborne Transmission
Likely or liable to be influenced or harmed by - Usually caused by water contaminated sewage
SUSCEPTIBLE HOST
pathogen B. Airborne Transmission
Reservoir and Susceptible Host are both EQUALLY DANGEROUS - Spread of agents by droplets in dust that travel more than
MODES OF TRANSMISSION 1m to host
III. VECTOR TRANSMISSION
 Animals that carry disease from one host to another, Arthropods
(insects) are the most important animal vector
A. Mechanical Transmission
- Passive transport of pathogens on insect’s body
- Fleas for bubonic plague
B. Biological Transmission
IV. OTHER METHODS
A. Blood Transfusion- hepatitis B, HIV
B. Transplacentral transmission- hepatitis B, Zika virus, Rubella
virus, HIV

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
To be a Pathogen, It is Must: Infection is caused by a microorganism
NONSPECIFIC INFECTION
 Gain entry to the host that is unknown
 Colonized the host’s tissue LATENT/QUIESCENT/DORMANT/ Generally indicates a mild infection;
 Resist the host’s defenses SUBCLINICAL INFECTION patient may be asymptomatic
o Host has a lot of mechanism of defense from pathogens. NOSOCOMIAL INFECTION Hospital acquired infection
o 1st line of defense would be physical and chemical barriers COMMUNITY ACQUIRED Infection obtained in the community
o 2nd line of defense would be complements (causes lysis of INFECTION during the course of our lives
organisms) Infection involving one infectious
SINGLE INFECTION
o 3rd line of defense would be the adaptive immunity, B and T agent only
cells. Infection cause by 2 or more
 Damage the host’s tissue MIXED INFECTION organisms, producing one or more
Events of Infection: diseases
 Factors influencing the occurrence of infection Infection lasting for a short period of
ACUTE INFECTION
1. Portal of entry time
- Skin, GIT, Respiratory tract, Genitourinary tract Infection lasting for a long period of
CHRONIC INFECTION
2. Virulence of the organism time
- Does it possess a capsule? Is it resistant to antibiotic? Is it Mechanism of Disease Production by Microbes:
resistant to other host factors? Can it evade the host’s I. Mechanical
immune system?  Involves invasion of tissues or surfaces
- Virulence factors: capsule, pili, LPS, endospores o Colonization of epithelial surfaces
3. Number of microbes o Penetration of epithelial cells and deeper
- The more there the number of microbes, the easier for structures
them to cause infection  Attributed to:
4. Defensive powers of the host a. Surface molecules that promote adherence to
Chain of Infection: susceptible cells by means of pili or fimbriae
1. Source/reservoir of infection b. Extracellular enzymes (collagenase, streptokinase,
2. Mode of transmission coagulase, etc.)
3. Portal of entry II. Chemical
4. Portal of exit  Production of substances that can cause destruction of body
tissues (e.g. hemolysins, lethal factor, necrotizing exotoxins)
 Toxin production
Feature EXOTOXIN ENDOTOXIN
Source Gram + & - Gram -
Location Extracellular Outer membrane
Toxicity Great Weak
Tissue affinity Specific Non specific
Chemical type Polypeptide LPS
Stability Heat labile Heat stable
Antigenicity High Weak
Converted to toxoid YES NO

Origin/Source of Infection-Pathogens: III. Immunological

 Once these pathogens are inside your body they cause disease  Interaction of the host’s immune mechanism and the invading
because they reproduce rapidly organism or its products
 Bacteria do this by splitting in two or binary fission Diseased Person can be:
 They often produce toxin at the same time, either exotoxin or  Patient- person who is sick
endotoxin  Case- person sick with a particular disease
 Viruses actually take over cells, damaging and destroying them  Contact- the person exposed to the disease
Types of Infection  Carrier- the person harboring the microorganism without sign and
Infection is confined to a limited area; symptoms of the disease
LOCAL INFECTION area involved determines severity of Course of Infectious Disease:
infection 1. Incubation Period
Infection is widespread → - First encounter with the pathogen
GENERALIZED INFECTION microorganisms are found even in the - Period of time extending from the introduction of
smallest capillaries of the body microorganisms to the host up to the time there are signs
Infection results in death of patient and symptoms of the disease
FULMINATING INFECTION
over a short period of time - May last for a few days to many years
Source of microorganisms is from 2. Prodromal Period
EXOGENOUS INFECTION
outside the body - Period of disease onset
Source of microorganisms is from 3. Invasion Period
ENDOGENOUS INFECTION
within the body - Period of maximum illness
Infection is cause by a microorganism - Outcomes: acute infection, chronic infection, carrier state
SPECIFIC INFECTION
that is known

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
Course of Infectious Disease continued….. Factors that Affects Communicability:
4. Convalescence 1. Ability of the bacteria to survive outside the body
- Stage during which the manifestations decline 2. Ability of the pathogen to survive the host’s immune system
- Period of Decline. Period of defervescence 3. Ability of the pathogen to establish the carrier state
- Signs and symptoms start to subside 4. Ability of the pathogen to survive in an intermediate host/vector
5. Ability of the pathogen to survive in a reservoir host
5. Recovery Epidemiology of Diseases
- Patient regains full strength

Pathogens/Products in Blood
BACTEREMIA Presence of bacteria in the blood stream
Presence of actively multiplying bacteria in
SEPTICEMIA
the blood stream
Disease involves a large number of
Presence of pus-producing bacteria in the EPIDEMIC
PYEMIA individuals in a short period of time
blood stream
Disease is constantly present in the
SEPTICOPYEMIA Combination of septicemia and pyemia ENDEMIC
community in low numbers
VIREMIA Presence of viruses in the blood stream
SPORADIC Disease occurs every now and then
Presence of saprophytes in the blood
SAPREMIA Disease is strange or alien to the
stream EXOTIC
community
TOXEMIA Presence of toxins in the blood
Disease occurring over a wide geographic
Portal of Exit/Method of Transmission:
PANDEMIC area, affecting an exceptionally high
 Site at which microbes leave body. Most common exit portals are
proportion of population
respiratory and gastrointestinal tracts
EPIZOOTIC Epidemic in lower animals
a. Respiratory Tract: respiratory carrier
ENZOOTIC Endemic in lower animals
- Exit discharges (mucus droplets) from nose and mouth
- Transmission by coughing, sneezing, spitting, etc. ZOONOTIC Disease primarily infecting lower animals
- Examples: Tuberculosis, influenza, etc. Carriers in Relation to Disease
b. GIT: fecal carrier Transmit the organism during incubation
Incubatory Carrier
- Transmit the organism through feces period of the disease
- Exits in feces Transmits the organism during the period
Convalescent Carrier
- Feces: Cholera, typhoid fever, salmonella of convalescence
- Saliva: Rabies virus, herpes simplex 1 Transmits the organism beyond the period
Chronic Carrier
c. Urogenital Tract: urinary carrier of recovery
- Exit or transmit through the urine Transmits the organism every now and
Intermittent Carrier
d. Skin and Wound infections then
- Spread through direct contact or through fomites Transmits the organism without showing
Healthy Carrier
e. Blood carrier signs and symptoms of the disease
- Transmit the organism through blood & its products Principal Function of the Immune System:
- Transmission through insects, needles and syringes  To protect humans from pathogenic microorganisms
- Insects: Malaria, yellow fever, etc.  Pathogenic microorganisms (Pathogens)
- Needles: AIDS and Hepatitis B and Hepatitis C - Microorganisms capable of causing infection and/or
disease
 Infection
- Ability of pathogen to enter host, multiply and stimulate
an immune response
 Disease
- Clinical manifestations associated with infection

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 MICROBIOLOGY
Normal Flora, Bacteria and Disease
Dr. Santos, Camilo
Immunologic Defense Mechanism:
 Natural Resistance
- Provides defense against infection by a number of
inherent, mechanical, and chemical barriers
 Nonspecific Defense Mechanism
 Immune Response
- Antibody
- Antigens
Prevention-Hygiene
Refers to conditions and practices that help
HYGIENE to maintain health and prevent the spread
of diseases
Medical hygiene therefore includes a specific set of practices associated with
this preservation of health, for example environmental cleaning, sterilization
of equipment, hand hygiene, water and sanitation and safe disposal of
medical waste.
Prevention-Sanitation
Generally refers to the provision of
SANITATION facilities and services for the safe disposal
of human urine and faeces
Is a major cause of disease world-wide and
improving sanitation is known to have a
INADEQUATE SANITATION
significant beneficial impact on health both
in households and across communities
The word 'sanitation' also refers to the maintenance of hygienic conditions,
through services such as garbage collection and wastewater disposal
Limitation of freedom of movement of
individual exposed to a communicable
QUARANTINE disease for a period of time equal to the
longest usual incubation period of the
disease
Separation of a group of individual to
SEGREGATION facilitate the control of a communicable
disease
Additional Key Terms
Inanimate object which can carry
FOMITE
microorganisms
Food, water, milk or biological substances
VEHICLE
which can carry microorganisms
Insects or other invertebrates which
VECTOR
transmit the infectious agent
Separation of the sick from others during
ISOLATION
the period of communicability

NOTE: According to Doc Santos, application daw yung approach ng tanong

in this topic 

REFERENCES
 Microbiology Manual (2018)
 PPT
 Dr. Santos Recordings

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