IN THE NAME OF ALLAH THE

MOST GRACIOUS AND THE

MOST MERCIFUL.
TOPIC: THE NORMAL
FLORA OF THE
RESPIRATORY TRACT
NORMAL FLORA
WHAT DO WE MEAN BY THE TERM NORMAL

FLORA?

• Normal flora is the term used to describe the various

bacteria and fungi that are the permanent residents of
certain body sites.
• These are often referred to as commensals (those that
derive benefit from another host but do not damage THAT
host)
• The term microbiome is often used to describe the normal
flora.
• The members of normal flora vary in both numbers and
kind from one site to another.

• These are present at the skin, oropharynx, colon, vagina,

nails, respiratory tract etc.

• Normal flora may aid the host, harm the host or exist as
commensals.
SIGNIFICANCE:-
• The normal flora influences the anatomy, physiology,
susceptibility to pathogens, and morbidity of the host.
• They prevent colonization by pathogens.
• They stimulate the production of antibodies.
• They may antagonize other bacteria.
• Some flora stimulate the development of certain tissues.
THE NORMAL FLORA
OF THE RESPIRATORY
TRACT
RESPIRATORY TRACT:-
• The passage formed by the mouth, nose, throat, and
lungs, through which air passes during breathing.
• It is divided into the upper and lower respiratory tracts.
• The upper includes the nasal cavity, pharynx and the
voice box (larynx).
• The lower includes the trachea, bronchi bronchioles and
the lungs.
UPPER RESPIRATORY TRACT:-
•  A largenumber of bacterial species colonize the upper
respiratory tract (nasopharynx). The nares (nostrils) are
always heavily colonized, predominantly
with Staphylococcus epidermidis and corynebacteria, and
often (in about 20% of the general population)
with Staphylococcus aureus, this being the main carrier site
of this important pathogen. The healthy sinuses, in contrast
are sterile.  The pharynx (throat) is normally colonized by 
streptococci and various Gram-negative cocci. Sometimes
pathogens such as Streptococcus pneumoniae,
Streptococcus pyogenes, Haemophilus
influenzae and Neisseria meningitidis colonize the pharynx.
LOWER RESPIRATORY TRACT:-
• The lower respiratory tract (trachea, bronchi, and
pulmonary tissues) is virtually free of microorganisms,
mainly because of the efficient cleansing action of the
ciliated epithelium which lines the tract. Any bacteria
reaching the lower respiratory tract are swept upward by
the action of the mucociliary blanket that lines the
bronchi, to be removed subsequently by coughing,
sneezing, swallowing, etc. If the respiratory tract
epithelium becomes damaged, as in bronchitis or viral
pneumonia, the individual may become susceptible to
infection by pathogens such as H. influenzae or S.
pneumoniae descending from the nasopharynx.
POINT TO PONDER:-
Air contains a large amount of
suspended organic matter and,
enclosed occupied spaces may hold
up to 1000 microorganisms/m3.
Almost all these airborne organisms
are pathogenic bacteria and fungi, of
which the average person inhales
approximately 10,000/day.
LIST OF THE RESPIRATORY FLORA:-
A-THE NARES (NOSTRILS)
• Corynebacterium
• Staphylococcus aureus
• Neisseria sp.
• Haemophilus sp.
• Various streptococci
• Staphylococci epedermidis
B-Upper respiratory tract
(NASOPHARYNX)

1.Neisseria sp.
2.Streptococcus pneumoniae
3.Streptococcus pyogenes
4.Hemophilus influenzae
NORMAL FLORA AS OPPORTUNISTIC
PATHOGENS:-
• The origin of the term opportunistic refers to the ability of
the microorganisms to take the opportunity offered by the
reduced host defenses to cause disease.
• Opportunistic pathogens are those that rarely, if ever,
cause disease in immunocompetent people but can
cause serious disease in immunocompromised patients.
• These opportunists are frequent members of the BODY’S
NORMAL FLORA.
They cause disease especially in host’s rendered
susceptible by:

• Radiation therapy and chemotherapy

• Perforated mucous membranes
• Immuno-suppression (AIDS and SCID)
• Rheumatic heart disease etc.
COMMON DISEASES CAUSED BY THE
RESPIRATORY FLORA:-
Streptococcal pharyngitis:-
A common upper respiratory infection, streptococcal
pharyngitis (strep throat) is caused by Streptococcus
pyogenes. This gram-positive bacterium appears as chains
of cocci.  The mucosal membranes of the pharynx are
damaged by the release of a variety of exoenzymes and
exotoxins by this extracellular pathogen
• Many strains of S. pyogenes can degrade connective tissues by
using hyaluronidase, collagenase and streptokinase.
• Streptokinase activates plasmin, which leads to degradation of
fibrin and, in turn, dissolution of blood clots, which assists in the
spread of the pathogen.
• Released toxins include streptolysins that can destroy red and
white blood cells.

SIGNS & SYMOTOMS:-

The classic signs of streptococcal pharyngitis includes:-

 a fever higher than 38 °C (100.4 °F).
 Intense pharyngeal pain
 Erythema associated with
pharyngeal inflammation
 Swollen, dark-red palatine tonsils,
often dotted with patches of pus
 Petechiae (micro capillary
hemorrhages) on the soft or hard
palate (roof of the mouth)
 The submandibular lymph nodes
beneath the angle of the jaw are
also often swollen.
 GLOMERULONEPHRITIS:-
• Acute glomerulonephritis also results from an immune
response to streptococcal antigens following pharyngitis.
Acute glomerulonephritis develops within 6–10 days after
pharyngitis. There are strong associations between specific
nephritogenic strains of S. pyogenes and acute
glomerulonephritis, and evidence suggests a role for
antigen mimicry and autoimmunity. However, the primary
mechanism of acute glomerulonephritis appears to be the
formation of immune complexes between S.
pyogenes antigens and antibodies, and their deposition
between endothelial cells of the glomeruli of kidney.
Inflammatory response against the immune complexes
leads to damage and inflammation of the glomeruli.
DISEASES CAUSED BY H. INFLUENZAE

• H. influenzae is a pleomorphic gram-negative

coccobacillus.
• Disease caused by Haemophilus influenzae can affect
many organ systems.
• Transmission occurs through direct contact with
respiratory droplets from a nasopharyngeal carrier or
case patient. Neonates can acquire infection by aspiration
of amniotic fluid or contact with genital tract secretions
containing the bacteria.
The most common types of disease
caused by H. influenzae include:-
 pneumonia
 bacteremia
 meningitis
 epiglottitis
 septic arthritis
 cellulitis
 otitis media
 purulent pericarditis.
Less common infections include
endocarditis and osteomyelitis.
 MENINGITIDES:-
• Neisseria meningitides also known as meningococcus is
the member of the human microflora.
• It is a Gram-negative bacterium that can cause meningitis
and other forms of meningococcal disease such as
meningococcemia, a life-threatening sepsis. It also cause
urethritis in men.
• The bacterium is referred to as a coccus because it is
round, and more specifically, diplococcus because of its
tendency to form pairs.
• N.meningitides is spread through
saliva and respiratory secretions
during coughing, sneezing,
kissing, chewing on toys and
even through sharing a source of
fresh water.
• About 10% of adults are carriers
of the bacteria in their
nasopharynx.
Scanning electron micrograph of a single
N. meningitides cell (colorized in blue)
with its adhesive pili (colorized in
yellow)
FUNGAL PNEUMONIA:-

• Fungal pneumonia is an infectious process in the

lungs caused by one or more endemic or
opportunistic fungi.
• Fungal infection occurs following the inhalation of
spores, after the inhalation of conidia, or by the
reactivation of a latent infection. 
• Opportunistic fungal organisms
(Candida species, Aspergillus specie
s, Mucor species) tend to cause
pneumonia in patients with
congenital or acquired defects in the
host immune defenses. 
• Pneumonia is the leading infectious
cause of death in developed
countries. Among the vast diversity
of respiratory pathogens, fungi
account for only a small portion of
community-acquired and nosocomial
pneumonias.
•  pneumoniais most common in people with chronic health
problems or weakened immune systems, and in people
who have inhaled large doses of the organisms.
• SIGNS & SYMPTOMS:-
• Cough, which may produce phlegm
• Fatigue
• Fever, sweating and shaking chills
• Nausea, vomiting or diarrhea
• Shortness of breath
• Chest pain when you breathe or cough
SHUKRAN
folks