NORMAL FLORA NORMAL FLORA OF THE HUMAN OF THE HUMAN

BODYBODYJANUARY 30, 2008JANUARY 30, 2008

MUTUALISTIC MUTUALISTIC RELATIONSHIPRELATIONSHIP

HOSTHOSTNUTRITIONAL NUTRITIONAL BENEFITSBENEFITS

STIMULATION OF STIMULATION OF THE IMMUNE THE IMMUNE SYSTEMSYSTEM

COLONIZATION COLONIZATION STRATEGIESSTRATEGIES

ORGANISMORGANISMNUTRIENT NUTRIENT SUPPLYSUPPLY

STABLE STABLE ENVIRONMENTENVIRONMENT

REASON FOR THEIR REASON FOR THEIR PREFERRED SITESPREFERRED SITES

TISSUE TROPISMTISSUE TROPISM

TISSUE TISSUE PREVALENCE/PREDILECTIONPREVALENCE/PREDILECTION

PRESENCE OF AN ESSENTIAL PRESENCE OF AN ESSENTIAL GROWTH GROWTH FACTORFACTOR

INHOSPITABLE ENVIRONMENTINHOSPITABLE ENVIRONMENT NORMAL FLORA’S SURFACE NORMAL FLORA’S SURFACE

COMPONENTSCOMPONENTS

FIMBRIAE, CAPSULES, PILIFIMBRIAE, CAPSULES, PILI

REASONS FOR REASONS FOR COLONIZATIONCOLONIZATION

BACTERIAL BACTERIAL BIOFILMSBIOFILMS

TISSUE TROPISM OF TISSUE TROPISM OF LACTOBACILLUS IN THE LACTOBACILLUS IN THE

G.U.T.G.U.T.

N.gonorrhoeae: piliN.gonorrhoeae: pili

SKINSKIN

HIGHEST NUMBER IN THE MOIST HIGHEST NUMBER IN THE MOIST AREASAREAS

MOST SUPERFICIAL LAYERS, MOST SUPERFICIAL LAYERS, UPPER HAIR FOLLICLESUPPER HAIR FOLLICLES

S.epidermidisS.epidermidis Micrococcus spp.Micrococcus spp. CorynebacteriumCorynebacterium

NONPATHOGENICNONPATHOGENIC COMMENSAL/MUTUALISTIC/COMMENSAL/MUTUALISTIC/

PARASITICPARASITIC MAY PROTECT AGAINST FUNGAL MAY PROTECT AGAINST FUNGAL

COLONIZATIONCOLONIZATION

Micrococcus spp.Micrococcus spp.

S.epidermidisS.epidermidis

RESPIRATORY TRACTRESPIRATORY TRACT

NOSTRILNOSTRIL

S.epidermidisS.epidermidis

S.aureus**S.aureus**

CorynebacteriumCorynebacterium SINUSESSINUSES

STERILESTERILE

URTURT

STREPTOCOCCUSSTREPTOCOCCUS

H.influenzaeH.influenzae

LRTLRT

STERILESTERILE

LOWER RESPIRATORY LOWER RESPIRATORY TRACTTRACT

LRT EPITHELIUMLRT EPITHELIUM

RESP.TRACT CILIARESP.TRACT CILIA

ORAL CAVITYORAL CAVITY

NUTRIENTS, DEBRIS, NUTRIENTS, DEBRIS, SECRETIONS:IDEAL ENVIRONMENTSECRETIONS:IDEAL ENVIRONMENT

AT BIRTH - STERILEAT BIRTH - STERILE

S.salivarius – UP TO 9 MONTHS S.salivarius – UP TO 9 MONTHS OF AGEOF AGE

S.mutans, S.sanguis – AFTER S.mutans, S.sanguis – AFTER TEETH TEETH ERUPTIONERUPTION

Bacteroides – PUBERTYBacteroides – PUBERTY

ANAEROBES - GINGIVAANAEROBES - GINGIVA

ORAL CAVITYORAL CAVITY

PREVENT GROWTH OF PATHOGENSPREVENT GROWTH OF PATHOGENS

NUTRIENT DEPLETIONNUTRIENT DEPLETION

PRODUCE FATTY ACIDS, PEROXIDESPRODUCE FATTY ACIDS, PEROXIDES STIMULATE LOW LEVELS OF IG, CROSS STIMULATE LOW LEVELS OF IG, CROSS

REACTREACT CAUSE HARM IF THEY ENTER TISSUESCAUSE HARM IF THEY ENTER TISSUES

B.melanogenicus - WOUNDSB.melanogenicus - WOUNDS

STREPTOCOCCUS – HEART VALVES, STREPTOCOCCUS – HEART VALVES, SUBACUTE BACTERIAL SUBACUTE BACTERIAL

ENDOCARDITISENDOCARDITIS

DENTAL PLAQUEDENTAL PLAQUE

LEADS TO CARIES, PERIODONTAL LEADS TO CARIES, PERIODONTAL DISEASEDISEASE

BIOFILM – 300 TO 500 CELL BIOFILM – 300 TO 500 CELL THICKNESSTHICKNESS

60-70%PLAQUE VOLUME: 60-70%PLAQUE VOLUME: BACTERIABACTERIA

MOST COMMON ORGANISMMOST COMMON ORGANISM

S. sanguis, S.mutansS. sanguis, S.mutans

S.mutans PRODUCE LACTIC ACID S.mutans PRODUCE LACTIC ACID FROM DIETARY CARBOHYDRATESFROM DIETARY CARBOHYDRATES

DEMINERALIZES TEETH ENAMELDEMINERALIZES TEETH ENAMEL LACTOBACILLI,ACTINOMYCES:LACTOBACILLI,ACTINOMYCES:

SECONDARY INVADERSSECONDARY INVADERS PERIODONTAL DISEASE: PERIODONTAL DISEASE:

ACTINOMYCESACTINOMYCES

GINGIVA, ALVEOLAR BONEGINGIVA, ALVEOLAR BONE

CONJUNCTIVACONJUNCTIVA

MOST DOMINANTMOST DOMINANT

S. epidermidisS. epidermidis

PROPRIONIBACTERIUM sppPROPRIONIBACTERIUM spp MECHANICAL WASHING OF MECHANICAL WASHING OF

TEARSTEARS LYZOZYME LYZOZYME LITTLE/NO OPPORTUNITY FOR LITTLE/NO OPPORTUNITY FOR

COLONIZATIONCOLONIZATION

N.gonorrhoeaeN.gonorrhoeae C.trachomatisC.trachomatis PRESENCE OF PRESENCE OF

SIALIC ACID SIALIC ACID RECEPTORSRECEPTORS

NEWBORN MAY NEWBORN MAY BE INFECTEDBE INFECTED

PROPHYLACTIC PROPHYLACTIC ANTIBIOTIC AT ANTIBIOTIC AT BIRTHBIRTH

NYC PROTOCOLNYC PROTOCOL

TETRACYCLINETETRACYCLINE ERYTHROMYCINERYTHROMYCIN 1%SILVER NITRATE1%SILVER NITRATE

UROGENITAL TRACTUROGENITAL TRACT

URINE- STERILEURINE- STERILE FLUSHING OF URINEFLUSHING OF URINE ANTERIOR URETHRAANTERIOR URETHRA

S.epidermidisS.epidermidis

ENTERIC BACTERIAENTERIC BACTERIA CONTAMINANTSCONTAMINANTS

VAGINAVAGINA

Lactobacillus acidophilusLactobacillus acidophilus

(Doderlein’s bacillus)(Doderlein’s bacillus)

METABOLIZES GLYCOGEN TO METABOLIZES GLYCOGEN TO LACTIC ACIDLACTIC ACID

LOW pHLOW pH

PREVENTS GROWTH OF MOST PREVENTS GROWTH OF MOST BACTERIA, YEAST (CANDIDA)BACTERIA, YEAST (CANDIDA)

GITGIT INFLUENCED BY THE AGE, DIET, INFLUENCED BY THE AGE, DIET,

SPECIFIC SITESPECIFIC SITE ESOPHAGUSESOPHAGUS

BACTERIA IN FOOD, SALIVABACTERIA IN FOOD, SALIVA STOMACHSTOMACH

RARERARELACTOBACILLILACTOBACILLIHELICOBACTER PYLORIHELICOBACTER PYLORI

Helicobacter pyloriHelicobacter pylori RELATED TO RELATED TO

GASTRIC ULCERS, GASTRIC ULCERS, CANCERCANCER

CLASS I CLASS I CARCINOGEN CARCINOGEN (WHO)(WHO)

20-30 YEARS 20-30 YEARS INFECTION---CAINFECTION---CA

MOST COMMON MOST COMMON BACTERIAL BACTERIAL INFECTIONINFECTION

H.PYLORIH.PYLORI

DETECTED BY THE C-13 OR C-14 DETECTED BY THE C-13 OR C-14 BREATH TESTBREATH TEST

ANTIBODY DETERMINATION TESTANTIBODY DETERMINATION TEST ENDOSCOPYENDOSCOPY

GIT NORMAL FLORAGIT NORMAL FLORA

PROXIMAL SMALL INTESTINEPROXIMAL SMALL INTESTINE

SPARSE GR(+) FLORASPARSE GR(+) FLORA

LactobacilliLactobacilli

S.faecalisS.faecalis DISTAL SMALL INTESTINEDISTAL SMALL INTESTINE

Coliforms (gram – bacilli)Coliforms (gram – bacilli)

BacteroidesBacteroides

LARGE INTESTINELARGE INTESTINE

+++COLIFORMS+++COLIFORMS

ANAEROBIC BACTEROIDESANAEROBIC BACTEROIDES

ANAEROBIC LACTOBACILLIANAEROBIC LACTOBACILLI

METHANOGENIC BACTERIAMETHANOGENIC BACTERIA

OUTNUMBER E.COLI 1,000:1 OUTNUMBER E.COLI 1,000:1 UP TOUP TO

10000:110000:1

GIT IN INFANTSGIT IN INFANTS

BIRTH – STERILE GITBIRTH – STERILE GIT BREASTFED INFANTS BREASTFED INFANTS

90% BIFIDOBACTERIA90% BIFIDOBACTERIA COW’SMILK, SOLID FOODCOW’SMILK, SOLID FOOD

BACTEROIDESBACTEROIDES

STREPSTREP

ENTERICSENTERICS

GIT TROPISMGIT TROPISM

GRAM (+)GRAM (+)

CAPSULESCAPSULES

LIPOTECHOIC ACIDS IN THEIR LIPOTECHOIC ACIDS IN THEIR WALLSWALLS

GRAM (-)GRAM (-)

FIMBRIAE BINDS TO THE FIMBRIAE BINDS TO THE GLYCOPROTEINS ON THE CELL GLYCOPROTEINS ON THE CELL SURFACESURFACE

BENEFITS OF THE BENEFITS OF THE INTESTINAL FLORAINTESTINAL FLORA

E.COLI SYNTHESIZES VITAMIN KE.COLI SYNTHESIZES VITAMIN K COMPETE FOR ATTACHMENT SITE COMPETE FOR ATTACHMENT SITE

OF PATHOGENIC SPECIESOF PATHOGENIC SPECIES STIMULATES GROWTH OF STIMULATES GROWTH OF

LYMPHOID TISSUESLYMPHOID TISSUES PRODUCTION OF CROSS PRODUCTION OF CROSS

REACTIVE ANTIBODIESREACTIVE ANTIBODIES

Predominant bacteria at various anatomical locations in adults.Predominant bacteria at various anatomical locations in adults.

SkinSkinstaphylococci and corynebacteria staphylococci and corynebacteria

ConjunctivaConjunctivasparse, Gram-positive cocci and Gram-negative rodSsparse, Gram-positive cocci and Gram-negative rodS

Oral cavityOral cavity

            teeth            teeth streptococci, lactobacilli           streptococci, lactobacilli           mucous membranesmucous membranes Streptococci and lactic acid Streptococci and lactic acid

bacteriabacteria

Upper respiratory tractUpper respiratory tract

            nares (nasal membranes)staphylococci and             nares (nasal membranes)staphylococci and corynebacteria            corynebacteria           

pharynx (throat) streptococci, neisseria, Gram-pharynx (throat) streptococci, neisseria, Gram-negative rods and coccinegative rods and cocci

Lower respiratory tractLower respiratory tract none none

GasTrointestinal tractGasTrointestinal tract

            stomach            stomachHelicobacter pyloriHelicobacter pylori (up to (up to 50%)50%)

                        small intestinesmall intestine lactics, enterics, lactics, enterics, enterococci, bifidobacteriaenterococci, bifidobacteria

                        coloncolon bacteroides, lactics, enterics, bacteroides, lactics, enterics, enterococci, clostridia, enterococci, clostridia, methanogensmethanogens

Urogenital tractUrogenital tract

            anteriOR urethra            anteriOR urethra sparse, sparse, staphylococci, corynebacteria, entericsstaphylococci, corynebacteria, enterics

                        vaginavagina lactic acid bacteria during lactic acid bacteria during child-bearing years; otherwise mixedchild-bearing years; otherwise mixed

Streptococcus pyogenes

Cell-bound protein (M-protein)

Pharyngeal epithelium

Streptococcus mutans

Cell- bound protein (Glycosyl transferase) Pellicle of tooth

Streptococcus salivarius

Lipoteichoic acidBuccal epithelium of tongue

Streptococcus pneumoniae

Cell-bound protein (choline-binding protein)

Mucosal epithelium

Staphylococcus aureus

Cell-bound proteinMucosal epithelium

Neisseria gonorrhoeae

N-methylphenyl- alanine piliUrethral/cervical epithelium

Enterotoxigenic E. coli

Type-1 fimbriae Intestinal epithelium

Uropathogenic E. coli

P-pili (pap) Upper urinary tract

Bordetella pertussis

Fimbriae ("filamentous hemagglutinin")

Respiratory epithelium

Vibrio cholerae

N-methylphenylalanine pili

Intestinal epithelium

Treponema pallidum

Peptide in outer membrane

Mucosal epithelium

Mycoplasma Membrane proteinRespiratory epithelium 

Chlamydia UnknownConjunctival or urethral epithelium