NORMAL FLORA OF HUMAN BEINGS
Human beings, like other animals, harbour a wide variety of micro-organisms either
on or in the body. The microbial population that inhabits a healthy normal person is called
normal microbial flora or microbiota. The microbial population of a normal human body is on
the order of 10¹⁴, and they include about 1012 bacteria. The normal microbial flora are constant
for each species and are broadly divided into resident flora and transient flora.
A constant, defined population which cannot be completely removed permanently is termed
resident flora, while those which vary from time to time and are non-permanent are known as
transient flora.
A healthy human foetus has no resident microbial population before the time of its birth. It
begins to acquire microbial population from the mother’s birth canal or vagina, and within hours
of birth, resident microbial populations establish on the skin, in the mouth, intestine, respiratory
tract, and so on.
The normal microbial flora play an important role in body economy. They have the following
significance,
Significance:
1. The resident flora of certain areas play an important role in maintaining health and
normal function.
2. The resident flora prevent colonisation (or) invasion of pathogens and possible diseases
through bacterial interference. The mechanism of bacterial interference may involve:
i. competition for receptors (or) binding sites on host cell
ii. competition for nutrients
iii. mutual inhibition by metabolic or toxic products
iv. mutual inhibition by antibiotic materials or bacteriocins
3. Members of resident flora in intestinal tract synthesize Vitamin-K and several B-
vitamins, which aid in the absorption of nutrients.
4. Raise the overall immune status of the host against pathogens.
Disadvantages:
They become pathogenic when host immune system gets defaulted; half of themselves
produce disease under certain circumstances. Suppression of normal flora allows the
entry of organisms from the environment or from other parts of the body. Such organisms
behave as opportunistic pathogens.
Normal flora organisms are adapted to the invasive mode of life. If forcefully removed
from that environment and introduced into the blood stream (or) tissues, these organisms
may become pathogenic.
Example: Streptococcus viridans are the most common resident organisms of the upper
respiratory tract. If large numbers of these are introduced into the blood stream, they may settle
on prosthetic heart valves and produce infective endocarditis.
Normal flora cause confusion in diagnosis due to this ubiquitous presence in the body and this
resembles to some of the pathogens.
Normal Flora of Skin:
An average human adult has about 2.1 m² of skin surface containing a variety of different micro
environments for colonization. It has two contrasting micro-environments for microbial
colonization. They are:
Larger, more accessible but hostile surface
Smaller, less accessible but hospitable skin glands
The surface of the skin is hostile, because it is relatively dry and salty, but it even contains
components of normal flora. Some gram +ve cocci including micrococcus, Staphylococcus
epidermidis, proliferate.
The important pathogen Staphylococcus aureus is commonly found on the skin of healthy
individuals. Other organisms commonly isolated from the human skin are diphtheroids,
Propionibacterium species, enteric bacteria, predominantly E. Coli. Most skin microbes are
associated directly or indirectly with sweat glands.
Examples: Staphylococcus aureus, Propionibacterium, Staphylococcus epidermidis,
diphtheroids, E. Coli, Micrococcus.
Eccrine sweat glands:
They are not associated with hair follicles and are unevenly distributed over the body, but occur
in dense concentrations on palms, soles of feet, and fingers. They are responsible for perspiration
of body fluids. These glands are relatively devoid of microbes.
Apocrine sweat glands:
These are most restricted in their distribution, being confined to the underarm and genital
regions. They are inactive in childhood and become fully functional only at puberty. Bacterial
populations are relatively high in these regions, and odour develops due to bacterial activity on
the secretion of the apocrine glands.
Sebaceous glands:
These are associated with each hair follicle and provide an attractive habitat for microbes. The
secretions of skin glands are rich in microbial nutrients like urea, amino acids, salt, lactic acid,
and lipids. The pH of human secretions is almost always acidic, the usual range being 4–6. The
most common bacteria associated with skin glands is anaerobic gram-positive Propionibacterium
acnes.
Non-pathogenic members of the genera Corynebacterium and Streptococcus are also present on
skin glands, and they are inhabited by large numbers of yeast belonging to the genus
Pityrosporum ovale. The major species Pityrosporum ovale utilizes lipids that are present in
these glands.
Most of the normal flora of the skin are transient. They vary from time to time. Although normal
flora of the skin usually plays a protective role, it acts as a pathogen in diseased conditions
known as Acne Vulgaris, which commonly occurs during adolescence.
When sebaceous glands are plugged, normally these glands produce a substance termed
as sebum which is formed when the cells in the lining of the glands die. They become
released into the glands or internal cavity, and the bacteria metabolize some of the
cellular components, producing sebum. In some individuals, sebum triggers an
inflammatory response causing redness and swelling. Swelling occurs due to the plugging
of the sebaceous glands and is called blackhead (or) pimple. Propionibacterium acnes has
been relatively identified as the organism responsible for producing the substance
(sebum) that causes inflammation. . P. acne produces lipases that hydrolyze the sebum
triglycerides to free fatty acids.Free fatty acids are especially irritating because they can
enter the dermis and promote inflammation This organism is extremely sensitive to the
antibiotic tetracycline
Normal Flora of Respiratory Tract:
In the upper respiratory tract, microorganisms lie primarily in areas bathed with the secretions of
mucous membranes. Bacteria enter the upper respiratory tract in large numbers during breathing,
but most of these are trapped in the nasal passage and expelled again with usual secretions.
The resident organisms that are normally found in nose are: Staphylococcus epidermidis,
Staphylococcus aureus.
Each person generally has a characteristic flora which may remain constant over an extended
period of time. Usually avirulent strains of Streptococcus pneumoniae, haemolytic streptococcus,
predominate in the nasopharynx of healthy individuals along with the members of genera
Neisseria, Staphylococci, Branhamella, Haemophilus, Corynebacterium, Moraxella species.
→ The lower respiratory tract includes trachea, bronchi and lungs, which are sterile in spite of
the large number of organisms which are potentially able to reach the region during breathing.
Dust particles which are of larger size are filtered out in the upper respiratory tract. As they pass
into LRT (lower respiratory tract), its rate of movement decreases markedly and the organism
settles on the walls of passages.
These walls are lined with ciliated epithelium and these cilia show upward beating and push
bacteria and other particles towards the upper respiratory tract from where they are expelled in
nasal secretions and saliva.
Only droplet nuclei of below 4–5 μm in size are able to reach the lungs, smaller bronchi
and alveoli.
Normal Flora of Digestive Tract:
All parts of the gastrointestinal tract are not hospitable to microorganisms. Oral cavity and large
intestine have much concentration of microorganisms than small intestine.
Oral Cavity: The mouth is warm, moist and has regular supply of fresh food and hence it is an
ideal growth habitat for microorganisms. The oral cavity of foetus is germ free until it passes
through the birth canal.
Feeding contact with people, new environment add many organisms. Although many organisms
may be introduced with food, drinks usually transient, rarely convert to resident.
Bacteria are most predominant group of microbes belonging to the genera Lactobacillus,
Staphylococci, Streptococci and Actinomycetes of the fungal members, the most commonly
found is Candida. It has been estimated that approximately 10% of the oral flora belongs to
Candida alone. In children and in aged ones, they are of major significance. Oral Candida
infections are often followed by thrush disease and skin lesions. This is because of the change in
bacterial population and results in imbalance in oral ecology.
Viruses in Oral Cavity: Little is known about the place of viruses in the normal oral ecology of
humans, but most of them, if present, are the causative organisms of cankers and sores. Herpes
simplex and measles viruses can be found in oral lesions during diseased conditions.
Role of Saliva:
Saliva is the most important source of microbial nutrients in the oral cavity, but it is not a good
microbial culture medium. Saliva contains about 0.5% dissolved salts, about half of which are
inorganic, and other organic constituents, especially proteins. These include salivary
glycoproteins, mucoproteins, and some serum proteins.
Small amounts of carbohydrates, urea, ammonia, amino acids, and vitamins are also
present. A number of antibacterial substances have been identified in saliva, of which the
most important enzymes are lysozyme, lactoperoxidase.
The lactoperoxidase enzyme is present both in milk and saliva and kills bacteria by a
reaction involving chloride ions and H₂O₂, in which singlet oxygen (nascent oxygen) is
probably generated, despite the activity of antimicrobial substances.
The presence of food particles and epithelial debris makes the oral cavity favourable to microbial
habitat.
Tooth and Oral Microflora:
Tooth provides surface for the growth of bacteria found in the oral cavity. During the first years
of life, they are predominantly acid-tolerant anaerobes, such as Lactobacillus, Streptococcus.
There is a pronounced shift of microflora towards obligate anaerobes. A thin film forms on the
surface of the tooth called dental plaque. It consists mainly of filamentous bacteria closely
packed on the surface of the teeth, embedded in an amorphous matrix.
These filamentous organisms are usually classified as fusiform bacteria. They are obligate
anaerobes. Associated with these are Gram-negative cocci, diphtheroids, streptococci, and
spirochetes.
Role of Oral Flora in Tooth Decay: The role of oral flora in tooth decay, i.e., dental caries, has
now been established in the tooth crevices where food particles are retained on the sides of tooth
decay. Two organisms have been implicated in dental caries: Streptococcus mutans and
Streptococcus sobrinus. Both these organisms are lactic acid-producing bacteria. Glucosyl
transferase plays an important role in caries (dental caries means disintegration of teeth).
Normal Flora of Gastrointestinal Tract:
The gastrointestinal tract is sterile in foetus up to the time of birth. Soon after birth, in most
sucking infants (bottle feeding), the microorganisms commonly found are primarily lactic acid
bacteria.
In breast-fed babies, species of Bifidobacterium predominate with further development. A wide
variety of complex interactions involving the individual’s environment and other factors regulate
the events establish the microbial flora of gastrointestinal tract.
The human GIT can be divided into three regions: stomach, small intestine, large intestine. The
normal flora of the tract varies with different regions.
Stomach: The pH of the stomach fluids is very low, about 2, hence it is not hospitable for
microorganisms and it can be viewed as a microbiological barrier against the entry of foreign
bacteria into the intestinal tract. Although the bacterial count of the stomach is generally low, the
stomach is often heavily colonized with acid-tolerant bacteria belonging to the genera
Lactobacillus and Streptococci.
Small Intestine: The small intestine is separated into three parts: duodenum, jejunum, ileum.
Duodenum: Duodenum is adjacent to the stomach and is fairly acidic and resembles the stomach
in its microbial flora. The bacterial population in the duodenum ranges from 100–1000
bacteria/ml. From the duodenum to ileum the pH gradually increases and becomes more alkaline.
Jejunum: In the duodenum and ileum, the jejunum is present. The duodenum and ileum are rich
in various bacterial members of the genera Enterococcus faecalis, Lactobacillus; yeast members
like Candida. The microbial population ranges from 1000–10,000 bacteria/ml.
In the lower ileum, bacterial population increases and accounts for 10⁵–10⁷ bacteria/ml of ileum
content. In this region, bacteria occur along with the digestive material.
Large Intestine: In large intestine, bacteria are present in enormous numbers and this region is
viewed as a specialized fermentation vessel. Many bacteria live within the lumen, probably using
some products of digestion as nutrients. Facultative anaerobes such as E. coli are present but not
abundantly with respect to other bacteria. These facultative anaerobes consume only O₂, thus
making the environment of large intestine strictly anaerobic and favourable for profused growth
of obligate anaerobes. Many of these bacteria are long, thin gram (–ve) rods with tapering ends,
called fusiform bacteria. Other obligate anaerobes include species of Clostridium and
Bacteroides.
The total number of obligate anaerobes is around 10¹⁰–10¹¹ cells/gm of intestinal contents. In
addition, Streptococcus faecalis is almost always present in significant numbers.
The common bacteria of intestinal tract are Bacteroides, Lactobacillus, Pepto-streptococcus,
Bifidobacterium species, E. coli, Pseudomonas, Proteus, Klebsiella, Streptococcus faecalis,
Bacteroides fragilis, Eubacterium aerofaciens, Clostridium sps., Enterobacter, Dibacterium
species, Staphylococcus, Ruminococcus, Coprococcus.
Factors Affecting Microbial Population:
1. The gut flora in humans vary quantitatively depending on diet. Habitual persons who
consume more fat and proteins show high number of Bacteroides and low number of
coliforms and lactic acid bacteria than those consuming vegetarian diet.
2. Use of wide-spectrum antibiotics disturbs the normal microbial flora of the gut, and
opportunistic pathogens like Proteus and Staphylococci, and Candida albicans colonize
the intestine.
Activities of Normal Intestinal Flora:
The important activity of intestinal flora in gas production is technically called flatus. The
phenomenon is called flatulence. Poorly digested food is fermented by anaerobes, resulting in the
production of H₂ and CO₂. In many individuals, methanogenic bacteria convert some of the H₂
and CO₂ into CH₄, but have a major effect on gas production.
If large quantities of beans are consumed, total gas production is increased four-fold. Another
common reason for gases in some individuals is poor absorption of milk sugar, lactose. If such
individuals with its abnormality do not eliminate milk from their diet, their intestinal bacteria are
stimulated to produce gas.
The intestinal flora has profound influence on a wide variety of metabolic reactions. Of special
note is the role of intestinal flora in modifying the composition of bile and bile acids.
Intestinal flora is sometimes very beneficial. In New Guinea, the people eat mainly sweet
potatoes, a food virtually devoid of N₂. Klebsiella pneumoniae is a constant member of the
intestinal flora of these people. Apparently, a significant N₂ is fixed and passed through the
intestinal wall into the blood stream. So that these individuals, subsistent on a diet that would be
unsuitable elsewhere, are able to manage.
Normal Flora of the Eye:
Lining of eyelids and covering the eye ball is a delicate membrane called the conjunctiva. The
conjunctiva is relatively free from organisms due to its flushing action of tears which has
lysozyme enzyme that act on cell wall of gram(+)ve bacteria. The organisms of the eye are
Staphylococci, Corynebacterium xerosis, moraxella species, Micrococci, haemolytic and non-
haemolytic Streptococci.
Normal Flora of Urinary Tract:
The different parts of the urinary tract in humans are kidneys, upper urethra (ureters), Urinary
bladder and lower urethra.
Kidneys are normally sterile and highly resistant to bacterial invasion. Upper urinary tract and
urinary bladder are also usually sterile, apparently because the urethral lining exerts antibacterial
effect and also frequent flushing of the epithelial surface of the urethra.
The lower urethra of both sexes is normally colonized by bacteria. The female urethra being
shorter (about 3-4 cm) than male urethra, it is much more frequently and heavily colonized by
bacteria.
The normal flora of male urethra comprise lactobacilli, nonhaemolytic streptococci,
Mycobacterium, diphtheroids, and Bacteroides Gram negative diplococci of Acinetobacter group
is also present. A protozoan Trichomonas vaginalis often colinize male urethra without causing
any symptoms
The principal resident flora female urethra are nonhaemolytic streptococci, staphylococci,
corynebacteria, Mycobacterium and occasionally coliforms. Unlike in males. The presence of
Trichomonas vaginalis leads to vaginal infection termed as trichomoniasis.
Normal Flora of Genital Tract:
The genital tract is essentially germ free except the distal parts viz., vulva and vagina in females
and distal urethra in males.
The typical normal flora of vulva comprises Staphylococcus epidermidis. Streptococcus faecalis,
corynebacteria, E. Coli and other coliforms.
The changes in the normal flora of vagina present a clear example of how changes in physiology
greatly influence the composition of normal flora) An important factor influencing these changes
in women is hormone estrogen produced by ovarian activity Estrogen normally stimulates the
vaginal mucosa to secrete the carbohydrate glycogen, The glycogen on the vaginal mucosa is
fermented by Lactobacillus acidophilus, often described as doderlein bacillus, producing the acid
thus resulting in low pH of the vagina
Before puberty, a girl produces little estrogen, little gycogen and has a vaginal pH of about 7.
These conditions favour the establishment of diphtheroids, staphylococci, streptococci and some
coliforms. As the hormone levels rise at puberty the vagina begins to deposit glycogen and the
flora shifts to the acid producing lactobacilli.
In the distal part of the genitalia of both sexes Mycobacterium smegmatis and Ureaplasma are
commonly found The preputial cheesy secretion of genitalia is called smegmum and one species
of Mycobacterium described as M. Smegmatis preferentially thrives in smegmum Occasionally
smegmum contaminates urine, and such contaminated urine samples when cultured produce
colonies similar to tubercle bacilli thus raising false alarm.
Genital flora of male & females:
Sex Part Bacteria
Female Vulva Staphylococcus, epidermidis
Corynebacteria, Escherichia coli, and
other coliforms Streptococcus faecalis
Vagina Lactobacillus acidophilus, Bacteroides,
melaninogenicus, Streptococcus faecalis,
Corynebacteria, Yeasts (Candida albicans)
Urethra Corynebacteria, Mycobacterium
smegmatis
Male Distal urethra Staphylococcus epidermidis
