a presentation from FARRAH ERMAN

Introducing

normal flora in GU tract

Microbe inside your GU tract !

What is normal?

What is abnormal?

How come?

We have features for every step of the way

Kinds of interactions between microorganism and host

a. mutualism - beneficial to both. b. commensalism - beneficial to one; not harmful to other. c. parasitism - beneficial to one; harmful to other. Majority of the normal flora - commensal or mutualistic relationship with the host. Example: 1011 bacteria/g fecal material - most harmless. This can change if: there is a change in the many chemical, cellular, and immunologic mechanisms that have evolved to prevent bacterial infections (underlying disease) local anatomic barriers are breached (trauma, instrumentation)

Factors that influence the kind and number of microorganisms at any body site are:
1. availability or unavailability of oxygen; 2. the availability of appropriate receptor sites for attachment; 3. the pH of the host site (stomach, vagina); 4. the availability of nutrients; 5. the influence exerted by other microorganisms at the site; 6. the immunological response of the host to the presence of the microbe. Normal flora = indigenous flora = autochthonous flora = commensals The skin, the oral cavity, the GI tract, and the female genital tract: resident normal flora Esophagus, urinary tract, and stomach - few microbes. Blood, spinal fluid, urine, and endothelial tissues - normally sterile.

Specific bacterial virulence factors: Colonization of surfaces mediated by adhesins.

Examples: fimbriae (pili) of some E. coli contain carbohydrate-specific receptors (lectins). P pili of E. coli bind to a-D-gal(1,4)-b-D-gal linked to a ceramide lipid of bladder epithelium. The adherent bacteria are not washed out of the bladder with the flow of urine.

 Bacterial invasion of host tissues

Most adherence does not lead to invasion unless mechanical or chemical injury allows the bacteria to penetrate the skin or intestinal epithelium.

Anatomical Lines of Defense

A. Acidity B. Everything goes out C. Mucosal lining D. Normal flora 1. Urinary bladder sterile 2. Vagina and urethra - lactobacilli, Staph. epid, diphtheroids, Strep. Sp E. A matter of distance -> urethra- rectum

What is normal?

Urine is normally sterile, and since the urinary tract is flushed with urine every few hours, microorganisms have problems gaining access and becoming established

The flora of the anterior urethra, as indicated principally by urine cultures, suggests that the area my be inhabited by a relatively consistent normal flora consisting of Staphylococcus epidermidis, Enterococcus faecalis and some alpha-hemolytic streptococci. Their numbers are not plentiful In addition, some enteric bacteria (e.g. E. coli, Proteus) and corynebacteria, which are probably contaminants from the skin, vulva or rectum, may occasionally be found at the anterior urethra.

IN WOMEN?

The vagina becomes colonized soon after birth with corynebacteria, staphylococci, streptococci, E. coli, and a lactic acid bacterium historically named "Doderlein's bacillus" (Lactobacillus acidophilus).

During reproductive life, from puberty to menopause, the vaginal epithelium contains glycogen due to the actions of circulating estrogens. Doderlein's bacillus predominates glycogen lactic acid. The lactic acid and other products of metabolism inhibit colonization by all except this lactobacillus and a select number of lactic acid bacteria. The resulting low pH of the vaginal epithelium prevents establishment by most other bacteria as well as the potentially-pathogenic yeast, Candida albicans. This is a striking example of the protective effect of the normal bacterial flora for their human host.

What is abnormal?

Recurrent urinary tract infections (UTIs) fall into one of two categories: Reinfection occurs after successful therapy for a UTI, is caused by bacteria from outside the urinary tract and characterized by varying, delayed recurrence with different strains. Relapse is caused by bacteria that persist within the urinary tract despite antimicrobial therapy and characterized by rapid recurrence with the same strain.

 healthy women: (Escherichia coli [E. coli], Staphylococcus saprophyticus) and risk factors (sexual intercourse, spermicide use, low vaginal estrogen, and genetic predisposition) that cause acute, uncomplicated cystitis (an inflammation of the bladder). Healthy young men: (lack of circumcision, or intercourse with a woman with a UTIthat cause acute, uncomplicated cystitis . In most of these women and some of these men, the infections are uncomplicated (the urinary tract has normal structure and function) and are cured and prevented by antimicrobial therapy. Sometimes typically in some young women, most elderly women, and most men UTIs are complicated. This means the urinary tract is functionally and structurally abnormal, the host is compromised, and/or the bacteria have increased virulence factors and/or antimicrobial resistance (Table 1). These factors increase the chance of acquiring bacteria and decrease the effectiveness of therapy.

ETIOLOGI

complicated UTIs are caused by a broad range of bacteria including E. coli, other gramnegative bacteria (including Proteus, Klebsiella, and pseudomonas species), and grampositive bacteria (enterococci and staphylococci).

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