1. Normal human flora
Dr.T.V.Rao MD
Dr.T.V.Rao MD

2. Human microbiome
The human microbiome (or human micro biota) is the aggregate of microorganisms that reside on the surface and in deep layers of skin, in the saliva and oral mucosa, in the conjunctiva, and in the gastrointestinal tracts. They include bacteria, fungi. Some of these organisms perform tasks that are useful for the human host. However, the majority have no known beneficial or harmful effect. Those that are expected to be present, and that under normal circumstances do not cause disease, but instead participate in maintaining health, are deemed members of the normal flora
Dr.T.V.Rao MD

3. Normal bacterial Flora
More bacterial than human cells in the body
provide some nutrients (vitamin K)
stimulate immune system, immunity can be cross-reactive against certain pathogens
Prevent colonization by potential pathogens (antibiotic-associated colitis, Clostridium difficile)
Dr.T.V.Rao MD

4. Overview of Human-Microbial Interactions
Microbial flora of the healthy human host 1) The reasons for understanding the normal flora of the healthy human body ▶ Normal flora vs. human body ▶ Some normal flora:  opportunistic pathogens when injury occurred,                                             when resistance of body decreased,                                             when moved to another site 2) Origin of the normal flora 3) Relationship between normal flora and human host 4) Distribution and occurrence of the normal flora
Dr.T.V.Rao MD

5. Where to find microbe? Everywhere!
Dr.T.V.Rao MD

6. Introduction of Normal Flora
A diverse microbial flora =>
Human body Area: the skin and mucous membranes
Time: shortly after birth until death
Number: 1014 bacteria =>1013 host cells
2. Normal flora may:
a. Aid the host
b. Harm the host (in sometimes)
c. Exist as commensals (no effect to the host)
Viruses and parasites => NOT normal microbial flora
Most investigators consider that they are not commensals and do not aid the host.
Dr.T.V.Rao MD

7. Normal Flora and Pathogenesis
Outcomes of exposure to a microorganism:
Transient colonization
Permanent colonization
Disease
Colonization vs. Infection
Colonization: establishment of a site of reproduction of microbes on a person without necessarily resulting in tissue invasion or damage.
Infection: growth and multiplication of a microbe in or on the body of the host with or without the production of disease.
Dr.T.V.Rao MD

8. Significance of Normal Flora
1.The normal flora influences the anatomy, physiology, susceptibility to pathogens, and morbidity of the host.
2. The effect of the normal flora on the host was not well
understood until germ-free animals became available.
Cesarean Section => Germ-free animals => Isolators w/o detectable pathogens (viruses, bacteria & others)
3. Two interesting observations:
a. the germ-free animals lived almost twice as long as their conventionally maintained counterparts.
b. the major causes of death were different in the
two groups.
Dr.T.V.Rao MD

9. Factors Influencing Normal Flora
Local Environment (pH, temperature, redox potential, O2, H2O, and nutrient levels…).
Diet
Age
Health condition (immune activity…)
Antibiotics,…..etc
Dr.T.V.Rao MD

10. Significance of Normal Flora
Normal flora may aid the host in several ways:
Aid in digestion of food
Help the development of mucosa immunity
Protect the host from colonization with pathogenic microbes.
106 pathogenic microbes
GI infection
w/ normal flora
10 pathogenic microbes
GI infection
w/ reduced flora after
Streptomycin treatment
Dr.T.V.Rao MD

11. Composition of the Normal Flora
The normal flora of humans are exceedingly complex and consist of more than 200 species of bacteria. The makeup of the normal flora may be influenced by various factors, including genetics, age, sex, stress, nutrition and diet of the individual. Three developmental changes in humans, weaning, the eruption of the teeth, and the onset and cessation of ovarian functions, invariably affect the composition of the normal flora in the intestinal tract, the oral cavity, and the vagina, respectively. However, within the limits of these fluctuations, the bacterial flora of humans is sufficiently constant to a give general description of the situation
Dr.T.V.Rao MD

12. Dr.T.V.Rao MD

13. When we get colonized with Normal Flora
A human first becomes colonized by a normal flora at the moment of birth and passage through the birth canal. In utero, the fetus is sterile, but when the mother's water breaks and the birth process begins, so does colonization of the body surfaces. Handling and feeding of the infant after birth leads to establishment of a stable normal flora on the skin, oral cavity and intestinal tract in about 48 hours.
Dr.T.V.Rao MD

14. A new born child's flora is dependent on mother
The composition of a child’s bacterial flora is dependent on the mother’s micro flora, since she is the primary source for the child’s bacteria at the outset
Dr.T.V.Rao MD

15. Density of normal flora in Humans
It has been calculated that a human adult houses about bacteria on the skin, 1010 in the mouth, and 1014 in the gastrointestinal tract. The latter number is far in excess of the number of eukaryotic cells in all the tissues and organs which comprise a human. The predominant bacteria on the surfaces of the human body are listed in Table 3. Informal names identify the bacteria in this table.
Dr.T.V.Rao MD

16. Normal Flora
Resident flora
Reflects sex of person
Dr.T.V.Rao MD

17. Potential colonization sites
Dr.T.V.Rao MD

18. Humans as Habitats
Colonization (and infection) frequently begin at mucous membranes
These are found throughout the body. Consist of single or multiple layers of epithelial cells, tightly packed cells in direct contact with the external _____________________________.
Bacteria may associate loosely or firmly
Breaches in the _______________ barrier can result in infection (pathogenesis)by opportunistic pathogens
Dr.T.V.Rao MD

19. Upper respiratory tract – and Lower Respiratory tract
Dr.T.V.Rao MD

20. Common Skin Bacterium May Be New Opportunistic Pathogen*
Helococcus kunzii is a recently identified bacterium that is thought to be a nonpathogenic member of normal human skin flora and is rarely associated with skin infections. In the study though, the researchers report the isolation of the organism from an infected cyst on the breast of a 57-year-old immunocompromised woman.
Finding provides further support for the opportunistic role of H. kunzii in causing infection in both immunosuppressed and immunocompetent patients," say the researchers.
A.H. Chagla, A.A. Borczyk, R.R. Facklam, and M. Lovgren Breast abscess associated with Helocococcus kunzii. Journal of Clinical Microbiology. 36: )
Dr.T.V.Rao MD

21. Associations Between Humans and the Normal Flora
E. coli is the best known bacterium that regularly associates itself with humans, being an invariable component of the human intestinal tract.  Even though E. coli is the most studied of all bacteria, and we know the exact location and sequence of 4,288 genes on its chromosome, we do not fully understand its ecological relationship with humans
Dr.T.V.Rao MD

22. commensal relationship.
Sometimes the relationship between a member of the normal flora an its host cannot be deciphered. Such a relationship where there is no apparent benefit or harm to either organism during their association is referred to as a commensal relationship. Many of the normal flora that are not predominant in their habitat, even though always present in low numbers, are thought of as commensal bacteria. However, if a presumed commensal relationship is studied in detail, parasitic or mutualistic characteristics often emerge.
Dr.T.V.Rao MD

23. Normal flora are Mutualistic
Much is not known about the nature of the associations between humans and their normal flora, but they are thought to be dynamic interactions rather than associations of mutual indifference.  Both host and bacteria are thought to derive benefit from each other, and the associations are, for the most part, mutualistic.  The normal flora derive from their host a steady supply of nutrients, a stable environment, and protection and transport. The host obtains from the normal flora certain nutritional and digestive benefits, stimulation of the development and activity of immune system, and protection against colonization and infection by pathogenic microbes.
Dr.T.V.Rao MD

24. Normal Flora of the Gastrointestinal Tract (GIT)
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:
1. Enterics
2. Bacteroides
3. Enterococci
4. Lactobacilli
5. Clostridia
Dr.T.V.Rao MD

25. Normal Microbial Flora of the Gastrointestinal Tract
Functions and Products of Intestinal Flora
Intestinal microbes carry out a variety of essential metabolic reactions that produce various compounds
The type and amount produced is influenced by the composition of the intestinal flora and the diet
Compounds produced include
vitamins B12 and K
gas
Dr.T.V.Rao MD

26. Dr.T.V.Rao MD

27. The flora of the large intestine (colon)
1. Enterococci
2. Clostridia
3. lactobacilli
4. Bacteroides
5. 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.
Dr.T.V.Rao MD

28. Normal Flora of the Respiratory Tract
A) The nares (nostrils)
1. Staphylococcus epidermidis
2. Corynebacterium
Staphylococcus aureus
4. Neisseria sp.
5. Haemophilus sp
6. Streptococcus pneumoniae
Dr.T.V.Rao MD

29. 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. Hemophilus influenzae
7. Neisseria meningitidis
Dr.T.V.Rao MD

30. 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).
Dr.T.V.Rao MD

31. Normal Flora of the Human Oral Cavity
Oral bacteria include:
1. Viridans streptococci
2. Lactobacilli
3. Staphylococci (S. aureus and S. epidermidis)
4. Corynebacterium sp.
5. Bacteroides sp.
6. Streptococcus sanguis (dental plaque)
7. Streptococcus mutans (dental plaque)
8. Actinomyces sp.
Dr.T.V.Rao MD

32. Sites of human body that the normal flora microbes colonize
Respiratory tract and head
outer ear, eye, mouth, oropharynx, nasopharynx
Sterile sites: sinuses, middle ear, brain, lower respiratory tract (trachea, bronchiole, lung)
Gastrointestinal tract
esophagus, stomach, small intestine, large intestine
Genitourinary system
anterior urethra, vagina
Sterile sites: bladder, cervix, uterus
Skin
Dr.T.V.Rao MD

33. Normal flora may act as opportunistic pathogens
Especially in hosts rendered susceptible by:
1. Immuno-suppression (AIDS & SCID)
2. Radiation therapy & Chemotherapy
3. Perforated mucous membranes
4. Rheumatic heart disease…etc.
Dr.T.V.Rao MD

34. Normal Flora absent in …
Sterile tissues
In a healthy human, the internal tissues such as:
blood
brain
muscle
cerbrospinal fluid (csf.)
are normally free of microorganisms.
Dr.T.V.Rao MD

35. Importance of The Normal Flora (Advantages)
1. They constitute a protective host defense mechanism
by occupying ecological niches.
Dr.T.V.Rao MD

36. Normal Flora of the Skin
The most important sites are:
1. Axilla
2. Groin
3. Areas between the toes
Dr.T.V.Rao MD

37. Importance of The Normal Flora (Advantages)
The oral flora contribute to immunity by inducing low levels of circulating and secretory antibodies that may cross react with pathogens.
Dr.T.V.Rao MD

38. 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.
Dr.T.V.Rao MD

39. Fecal bacteriotherapy
Fecal bacteriotherapy, which is now officially and scientifically known as fecal micro biota transplantation and is also referred to as fecal micro biota therapy, fecal transfusion, fecal transplant, stool transplant, fecal enema or human probiotic infusion (HPI), is a medical treatment for patients with pseudomembranous colitis (caused by Clostridium difficile), or ulcerative colitis that involves restoration of colon homeostasis by reintroducing normal bacterial flora from stool obtained from a healthy donor.
Dr.T.V.Rao MD

40. Fecal micro biota transplantation
Fecal micro biota transplantation (FMT) -- also known as fecal bacteriotherapy, among other names -- is an effort to calm a troubled bowel by reintroducing the vast diversity of collaborative bowel inhabitants after the usual mix has been disturbed. More than 1,000 different strains of bacteria co- exist peacefully in the typical healthy bowel. But when the delicate balance is altered, by antibiotics or other causes, a few strains can become dominant, leading to severe diarrhea, inflammation and tissue damage.
Dr.T.V.Rao MD

41. microbiota transplantation
Like an organ transplant, fecal microbiota transplantation begins with finding a donor, often a family member. The treatment team collects a fresh stool sample, at least 200 to 300 grams. The sample is mixed with salt water in a blender and filtered to remove particulate matter. It can be administered to the recipient through a colonoscopy, as an enema, or -- when the inflamed region is higher in the colon -- through a naso-gastric tube.
Dr.T.V.Rao MD

42. Programme created by Dr. T. V
Programme created by Dr.T.V.Rao MD for Medical and Paramedical students in the Developing World
Dr.T.V.Rao MD