Define Normal Flora:
Bacteria (including mycoplasma), yeast, and protozoans which inhabit the skin and mucosa of healthy persons
10^13 cells; 10^14 bacteria
What are three characteristics of normal flora:
1. Resident -- what you expect
2. Transient -- edging towards pathogenic, high turnover rate (e.g. S aureus)
3. Usually commensal -- (you are food and shelter !)
Why is it that highly invasive bacteria causes diarrhea in adults but not in newborns?
This exhibits the idea that specificity of receptors on cells changes with age --- newborns have yet to develop the associated receptor
What is bacterial interference?
1. Bacteria compete for binding sites
2. Compete for nutrients
3. Elaborate antibacterial factors vs. pathogens
NF compete with pathogenic bacteria
What benefit do NF provide?
1. Metabolism in the GI tract (b/d nutrients for absoprtion)
2. Stiulation of GI and other mucosal immune sites, cells, systems (i.e. priming of innate and adaptive immunity)
3. Development of cross reactive, protective antibodies on surface of bacteria
Loss of normal flora often leads to what?
1. Sites for pathogen adherence
2. Absence of interference allows replication after adherence
3. Skin, respiratory, GI and GU mucoae all are susceptible to adverse effect
INCREASED SUSCEPTIBILITY TO INVASION BY PATHOGENS
How can normal flora be potential pathogens?
If they penetrate the mucosa that they are living in --- can change the local environment -- causing disease
EX: adherence to perineal and vaginal surface --> UTI
Skin trauma introduces bacteria -- especially transient NF such as S. aureus -- to new adherence sites.
What are the 4 determinants of NF?
2. Menstrual status
3. Environment (temperature, humidity)
4. Diet/nutritional state
What NF is common to the nose (skin and mucosa)?
1. Corynebacterium spp
2. S. epidermidis (resident)
3. S. aureus (transient)
What NF is common to the oral mucosa?
1. alpha hemolytic streptococci
2. gram negative anaerobic bacilli, facultative cocci, actinomycetes (dental plaques), protozoans, and candida (fungus) **** more likely to cause problem
NF of pharynx:
Alpha streptococci, gram negative anaerobic bacilli, and cocci, gram positive anaerobic occic, haemophilus spp, actinomycetes
EXCEPT TRACHEA --- = sterile except in chronic lung disease; should not have bacteria below larynx except in smokers
NF of stomach?
Normal acid level --> very few --- primarily streptococci and lactobacillus (unlikely to infect, but perhaps inflammation)
Low acid level -- MANY ORGANISM -- higher density, increased yeast -- starts to look like small bowel
There is increasing density of NF as you move more distally in the small bowel - True or False?
True --- enterococci, facultative gram negative bacilli, anaerobic bacteria the further you go
Perforation to distal bowel results in disease dominated by what?
Anaerobes --- (Anaerobic bacteria exist further down in bowel)
NF of the colon?
Favorable spot for anaerobic gram negatives and gram positives
10^11/g ... >150 identified strains
Anaerobic gram positive bacilli, anaerobic gram negative bacilli, facultative gram negative bacilli, enterococci
E. Coli -- 2-4% --- high turnover
What is the NF of the vagina?
Vagina is most sensitive to need for NF to maintain mucosal health
Lactobacilli (pH <4.5 maintained)
Changes with time
Group B streptococcus during reproductive time = transient NF
What is the NF of the urethra?
--- small numbers of perineal and cutaneous organisms
Kept in check by normal urine flow
Urinary function impairment = PROBLEMO
When do NF become pathogens?
Most NF are intrinsically non-invasive in situ and in normal host.
Transient NF are more likely to be pathogenic with a little push.
1. Trauma to Mucosa
2. Bronchogenic aspiration
3. Perforation of GI mucosa or bowel
Trauma, Injury, and penetration of the oral mucosa are associated with what consequences?
1. Dental trauma -- > hemoyltic strep --> bacteremia, endocarditis
2. Penetration --> polymicrobial necrotizing infection and abscess
3. Injury (by another infectious disease)--> abscess, tonsilar
What happens with aspiration of oral flora?
Pneumonia (inflammation of the lungs) or lung abscess (destruction of tissue and replacement by white blood cells
How can you mess up the NF?
Antibiotics -- decrease bacterial interference allowing:
1. Attachment of pathogens (respiratory mucosa, skin)
2. Replication of pathogens (GI)
3. Loss of protective pH (vagina)
4. Increased susceptibility to enteric pathogens like salmonella, etc.
5. The clostridium difficult problem (lose colon's function to absorb water)