The term “normal microbial flora” denotes the population of microorganisms that inhabit the
healthy normal persons. Normal flora basically consist of bacteria and Fungi that are permanent
residents of body sites specially skin, oropharynx, colon and vagina. Viruses and protozoa which
are major groups of microorganisms are not considered members of normal flora. In a healthy
human, the internal tissues, e.g. blood, brain, muscle, etc., are normally free of microorganisms.
The skin and mucous membranes always harbor a variety of microorganisms.
It has both advantages as well as disadvantages.
Advantages
(i) They prevent or suppress the entry of the pathogens.
(ii) These synthesize the vitamins especially Vit.-K and several B Group vitamins.
(iii) Antigenic stimulation provided by intestinal flora is considered important in ensuring the
normal development of the immune system.
(iv). Antibodies produced in response to normal flora cross react with pathogens thus raising
immune status of the host.
Disadvantages
(i) They become pathogenic when the immunity is lowered.
(ii) 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).
(iii) Normal flora may cause confusion in diagnosis due to their ubiquitous presence in the body
and their resemblance to some of the pathogens
Origin of Normal Flora
Healthy fetus in uterus is free from microorganisms. During birth the infant in exposed to vaginal
flora. Within a few hours of birth oral and nasopharyngeal flora develops and in a day or two
resident flora of the lower intestine appears.
Normal Flora of the Skin
Dryness of skin, Low pH, fatty acids in sebaceous secretions and presence of lysozymes are
important factors for eliminating non-resident microorganisms from the skin.
The secretions of sweat gland and sebaceous glands provide water, aminoacids, urea,salts and fatty
acids which can serve as nutrients for these microorganisams. The predominant resident
microorganisms of the skin are corynebacterium, propionibacterium, Staphylococcus epidermidis,
occasionally S aureus, and peptostreptococcus species. (viridians streptococci) and enterococci
(enterococcus species); and gram-negative coliform bacilli and acinetobacter. Candida may occur
on scalp and around nails.
Normal skin inhabits 102 - 104 organisms /sq. cm.
Normal Flora of Respiratory Tract
Normal Flora of the Mouth
The mouth contains micrococci, gram positive aerobic spore bearing bacilli, coliforms, proteus
and lactobacilli. The gums pockets between the teeth and crypts of the tonsils have a wide spectrum
of anaerobic flora like fusiform bacilli, treponemes, lactobacilli, etc. Candida is also found.
Mucus membrane of respiratory tract present an environment which is difficult for many kind of
bacteria to colonize. Due to movement of cilia mucus layer flows downwords and trapped bacteria
are swallowed and destroyed by acid of stomach. Lysozyme present in mucus also exert
bactericidal effect.
Within 12 hours of birth alpha hemolytic streptococci are found in upper respiratory tract and
become the dominant organism of the oropharynx and remains so for the whole life. In the pharynx
and trachea, similar flora is established. Smaller bronchi and alveoli are normally sterile
Normal Flora of Gastrointestinal Tract:
The GI Tract of the fetus in uterus is sterile. It becomes contaminated with organisms shortly after
birth. In breast fed infants, the intestine contains lactobacilli, enterococci, colon bacilli and
staphylococci. In bottle fed infants the intestine contains anaerobic lactobacilli, colon bacilli and
aerobic and anaerobic spore bearing organisms. With the change of food, flora changes. Diet has
a marked influence on the composition of the intestinal and fecal flora.
In the stomach as pH is low, the stomach is sterile but as the pH increases in small intestine the
number of bacteria increases progressively beyond the duodenum to the colon. The bacterial count
is low in small intestine as compared to large intestine. Lactobacilli and entrococci predominate in
the duodenum and proximal ileum. The bacterial flora is similar in lower ileum, caecum and
rectum. The anaerobic condition of colon is maintained by aerobic bacteria which
utilizes the free oxygen.
Normal flora of Genitourinary Tract
The vaginal flora of adult women consists of lactobaccilus specie that produce acid to keep pH
low. About 15-20% of women carries beta streptococci in vagina which is an important cause of
sepsis and meningitis in new born acquired during passage through birth canal. Urine in bladder
is sterile in healthy person but contaminated during passage through urethra by streptococcus
epidermis, coliforms, diptheroid and streptococci.
