BACTERIAL NORMAL FLORA

J. Obila
 INTRODUCTION
• Normal bacteria flora describes bacteria and fungi that are
permanent residents of certain body sites without causing a
disease.
• Viruses and parasites are never considered members of the
normal flora
• Human first becomes colonized by normal flora at birth
• They vary in number and kind from one site to another
• The internal organs and the blood are usually sterile and
presence of bacteria on these sites is an indication of
disease.
• Produce endogenous diseases- Mostly opportunistic
infections
• Fall in two categories:
1. Transient Flora
– Inhabit the skin and mucous membrane for a short
period then disappear
– Are derived from the environment
– Cannot produce disease unless when in large numbers

2.Resident Flora
– Are fixed and found in certain parts of the host
– Re-establish themselves if they are disturbed
• Distribution of normal flora is influenced by;

Temperature Environment
pH of the secretions Diet
Availability of oxygen Anatomic parts; e.g. vaginal flora
and moisture is more susceptible to infection
Gender and hormonal General health of the person
activity Age of the individual

• All these may be reduced by antimicrobial

agents and hormonal activity
• The parts in the body that lack flora include;
– Trachea, bronchi, bronchioles, alveoli: They have
ciliated epithelium and have phagocytotic cells
– GIT: Esophagus-may have a few transient flora,
Stomach, its low pH protects it from harm, upper part
of ileum
– Muscle tissue
– Pericardium
– Kidneys, ureters, upper part of urethra, bladder
– Circulatory system-Blood
– Central nervous system, cerebrospinal fluid
• Parts of the body with abundant flora include;
– Skin
– Mouth
– Colon
– Lower female genital tract(vagina)
– Lower part of male urethra
– Upper respiratory tract
 Importance of Resident Flora
 Serve a nutritional function
• synthesizes and excretes vitamins in excess of their own needs, which can
be absorbed as nutrients by their host e.g enteric bacteria secrete Vitamin
K and Vitamin B12, and lactic acid bacteria produce certain B-vitamins.
 Constitute protective host defense mechanism
 Prevent colonization by pathogens by competing for attachment sites or for
essential nutrients. 
 Produce substances which inhibit or kill pathogenic bacteria. E.g intestinal
bacteria produce a variety of substances ranging from fatty acids and
peroxides to highly specific bacteriocins, which inhibit or kill other bacteria.
 They stimulate the production of natural antibodies. Since the normal flora
behaves as antigens in an animal, they induce an immunological response
there by prevent infection or invasion.
 Carry out metabolic protective mechanisms e.g. in vaginal flora, they maintain the pH
of secretions
 Disadvantages of Resident Flora
 Agents of disease -cause endogenous disease if they reach a site or tissue
where they cannot be restricted or tolerated by the host defenses especially
in inmminocompromised individuals.
 If large numbers of them are introduced into the bloodstream (e.g. following
tooth extraction or tonsillectomy), they may settle on deformed or prosthetic
heart valves and produce infective endocarditis
 May help the pathogen to grow
 Examples a member of the normal flora supplying a vitamin or some other
growth factor to a pathogen in order to grow.
 Another example occurs during treatment of staphylococcal infections
when a penicillin-resistant staphylococcus that is a component of the
normal flora shares its drug resistance with pathogens that are otherwise
susceptible to the drug.
 Competition for nutrients Bacteria in the gastrointestinal tract absorb some
of the host's nutrients for their own needs.
 Normal flora of the skin
• About 103 -104 organism/ cm2
• Varies with density and composition.
• Has a transient flora e.g. Gram +ve cocci/bacilli and yeast
• Has secretions of low pH e.g. sebaceous secretions with low pH,
enzymes and other factors like lysosomes, sweating and
washing though this just reduces normal flora, it does not
eliminate.
• The skin flora is important because some procedures involving
going through the skin need hygiene and care to avoid
penetration of infection through the opening.
• The majority of skin microorganisms are found in the most
superficial layers of the epidermis and the upper parts of the
hair follicles.
 Staphylococcus epidermidis
 Is the predominant organism but can cause diseases at certain sites such as artificial heart
valves and prosthetic joints
 Staphylococcus aureus
 Staphylococcus aureus is found on the face and hands, particularly in individuals who are nasal
carriers
 Micrococci
 Not common; however, they are frequently present on normal skin. Micrococcus luteus-
predominant species,
 Streptococci
 Streptococci, especially β-hemolytic streptococci, are rarely seen on normal skin.
 Propionibacterium and Peptococcus are situated in the deeper follicles because they require low
oxygen.
 Candida albicans is also normal flora of the skin tho may enter the body through needle pricks
and cause systemic infections especially in immunocompromised individuals.
 Gram-Negative Bacilli
 Enterobacter, Klebsiella, Escherichia coli, and Proteus spp. are the predominant Gram-negative
organisms found on the skin.
 Acinetobacter spp also occurs on the skin of normal individuals; is more common in the moist
areas.
 Nail Flora
 Aspergillus, Penicillium, Cladosporium, and Mucor are the major types of fungi found under the
nails.
 Respiratory Tract Flora
 Some people have gram +ve bacteria in their noses
 The nostrils are predominantly colonized, with Staphylococcus
epidermidis, corynebacteria, and often Staphylococcus aureus.
 Pharynx is colonized predominantly-streptococci and Neisseria
spp and sometimes pathogens e.g Streptococcus pneumoniae,
Haemophilus influenzae, diphtheroids, mycoplasmas and
Neisseria meningitidis.
 The lower respiratory tract (trachea, bronchi, and pulmonary
tissues) is free of microorganisms due to cleansing action of
the ciliated epithelium which lines the tract
 Damage of the respiratory tract epithelium increases
susceptibility to infection by pathogens such as H. influenzae
or S. pneumoniae descending from the nasopharynx. 
 Normal Flora of the Oral Cavity
 Nutrients, epithelial debris, and secretions makes the mouth a favorable
for a great variety of bacteria.
• Has gram +ve bacilli
• Anaerobic bacteria are in plenty and at times even presence of yeast
 Oral bacteria include streptococci, lactobacilli, staphylococci and
corynebacteria, with a great number of anaerobes, especially
bacteroides.
 At birth the oral cavity is sterile but becomes colonized in the first
feeding.
 Streptococcus salivarius is dominant and may make up 98% of the total
oral flora until the appearance of the teeth (6 - 9 months in humans).
 The eruption of the teeth during the first year leads to colonization by S.
mutans and S. Sanguis persist as long as teeth remain.
 Bacteroides and spirochetes colonize around puberty.
 Other strains of streptococci adhere to the gums and cheeks but teeth.
 The normal bacterial flora of the oral cavity benefit from host nutrients and
habitat.
 The normal flora occupy available colonization sites which makes it more difficult
for other microorganisms to become established.
 Also, the oral flora contribute to host nutrition through the synthesis of vitamins
and they contribute to immunity
 Oral bacteria produce inhibitory substances such as fatty acids, peroxides and
bacteriocins.
 On the other hand, the oral flora are the usual cause of oral diseases -abscesses,
dental caries, gingivitis, and  periodontal disease.
 May gain entry into deeper tissues and cause abscesses of alveolar bone, lung,
brain, or the extremities e.g oral streptococci introduced into wounds during
dental surgery may adhere to heart valves - bacterial endocarditis.
 Eikenella corrodens also a member of the oral flora and may cause skin and soft
tissue infections
 Anaerobic bacteria such as bacteroides, fusobacteritum, clostridium,
peptostreptococcus , Actinomyces odontolyticus, anaerobic spirochetes and
Actinomycetes israelli are found in gingival crevices where oxygen level is low.
These organisms can cause lung abscess in debilitated patients with poor dental
hygiene.
 Gastrointestinal Tract Flora
 At birth the entire intestinal tract is sterile, bacteria enter with the first feed.
 In breast-fed infants, bifidobacteria account for more than 90% of the total intestinal
bacteria. Enterobacteriaceae, enterococci, bacteroides, staphylococci, lactobacilli
and clostridia-low proportions.
 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 and clostridia. 
 Human milk contains a growth factor that enriches for growth of bifidobacteria, -play
a role in preventing pathogens from colonization of the infant intestinal tract
 Bacteria in the human GI tract produce vitamins -contribute to nutrition and
digestion.
 Also protect their host from establishment and infection by pathogens and ability
stimulate immune system
 Alterations in the GI flora- poor nutrition or antibiotics can lead to gastrointestinal
disease.e.g Treatment with antibiotics may allow certain anaerobic species to
become predominant and cause disease. For example, Clostridium difficile
-pseudomembranous colitis.
• Small intestine
 Small number of flora e.g streptococci, lactobacilli, Enterococcus faecalis,
candida albicans, occasionally coliforms (e.g E. coli) and Bacteroides.
 Some Helicobacter species can colonize the stomach and are associated with
gastritis and peptic ulcer disease.
 Small count due to; Acidity lowers, Rapid peristalsis and the presence of bile

• Large intestine
 Flora, qualitatively similar to that found in feces (1011/g feces) .
 Where >90% are anaerobes.
 Coliforms, enterococci, clostridia and lactobacilli can be regularly found
 Predominant species are anaerobic Bacteroides and anaerobic Bifidobacterium
(Bifidobacterium bifidum), Eubacterium, and Peptostreptococcus, Clostridium
and Candida
 The colon flora is important due to;
 Causing infection to adjacent tissues during trauma
 Movement to another site is prone hence need of a mechanism to prevent this
 The strict anaerobic conditions and bacterial waste products inhibit the growth
of other bacteria
 Urogenital Tract
 Urine is normally sterile
 The flora of the anterior urethra, is inhabited by
Staphylococcus epidermidis, Enterococcus faecalis, some
alpha-hemolytic streptococci and diphtheroids.
 Occasionally E. coli, Proteus, Neisseria (nonpathogenic species)
and corynebacteria, which are probably contaminants from
the skin, vulva or rectum.
 The area around the urethra of women and uncicumsised men
contains secretions that carry Mycobacterium smegmatis.
 The skin surrounding the genitourinary tract contains
Staphylococcus saprophyticus major cause of UTI in women.
 Vagina
 Bacterial flora in the vagina depends on the age, pH, and hormonal levels
of the host. Lactobacillus spp. predominate in female infants (vaginal pH,
approximately 5) during the first month of life.
 Glycogen secretion seems to cease from about I month of age to puberty.
During this time, diphtheroids, S. epidermidis, streptococci, and E. coli
predominate at a higher pH (approximately pH 7).
 At puberty, glycogen secretion resumes, the pH drops, and women
acquire an adult flora- L. acidophilus, corynebacteria, peptostreptococci,
staphylococci, streptococci, and Bacteroides predominant.
 After menopause, pH again rises, less glycogen is secreted, and the flora
returns to that found before puberty
 Low pH of the vagina prevents establishment by bacteria and potentially-
pathogenic yeast
 The vaginal flora is important because it can cause infection during
childbirth and can reach the urinary tract causing infection (UTI)
 Conjunctival Flora
 The conjunctival flora is sparse.
 Lysozyme, secreted in tears, play a role in controlling the
bacteria by interfering with their cell wall formation.
 Blinking wipes the conjunctiva by mechanically washing
away foreign objects
 Staphylococcus epidermidis and Propionibacterium acnes
are dominant.
 Staphylococcus aureus, some streptococci, corynebacteria,
Haemophilus sp. and Neisseria sp. are occasionally found.
 Pathogens which infect the conjunctiva (e.g. Neisseria
gonorrhoeae and Chlamydia trachomatis) are able to
specifically attach to the conjunctival epithelium