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NORMAL FLORA OF

THE SKIN

Department of Microbiology FKUj


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Pendahuluan
• Flora normal : kumpulan mikroorganisme
yang secara alami terdapat pada tubuh
manusia normal dan sehat.
• Umumnya dari jenis bakteri.
• Dapat menyebabkan penyakit bila
ditempatkan pada tempat yang tidak
semestinya atau ada faktor predisposisi

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Why is it called the Normal Flora ?

The terms flora is used because the majority


of the organisms concerned are bacteria

It has been estimated that humans have


approximately 1013 cell in the human body
and something like 1014 bacteria associated
With them.
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• The normal flora also called
indigenous flora

• Microorganisms that are commonly


found on or in body sites of healthy
persons

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• Organism found in other tissues
e.g brain, heart, muscle, bone
– not normal flora
(Expected to cause disease)

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The relation ship between symbiotic
association

Most species are independent of other species or rely on


them only temporarily for food (e.g. predator and prey).

Some species form closer association termed symbiosis


and there are three major categories :

a. Commensalisms :
one species of organism uses the body of a
larger species (Staphylococcus growing on the skin
typically causes no measureable harm to a person )

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b. Mutualism :
relationship provide reciprocal benefits for
two organism involved (bacteria in
human colon)

c. Parasitism :
the symbiotic relation ship benefits only the
parasite (tuberculosis bacteria in human
lung)
Any parasite that can causes diseases is
called a pathogen
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Normal flora can be resident or transient

Resident :
– present invariably or for months in a
particular site
– Resident flora can be reduced by washing
but not eliminated

• Transient :
– present briefly, rest on body surface but do
not persist
– Transient flora can be eliminated by
washing
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• Hospital workers have large transient flora of
pathogens due to exposure
– e.g Staphylococcus aureus – harmless to
health workers but not to some patients
(open wounds, elderly)

• Carrier state
– A term used when potentially pathogenic
organisms are involved
– e.g Streptococcus pneumoniae, Neisseria
meningitidis
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• Normal flora is not static, constant change

• Depends on
– Age
– Nutritional status of the site
– Diseases states
– Drug or antibiotic effects
– pH
– oxidation-reduction potensials

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Disturbed balance
– may lead to infection

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• Opportunists
Cause disease when ‘opportunity’
arises
• breakdown in immune system
• Treatment with broad spectrum
antibiotics
• Implantation of devices e.g catheters,
prostheses
• Normal flora can be opportunistic
–e.g Candida albicans during antibiotic
therapy
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Distribution of some members of the normal flora of the human body

Skin :
Stap. epidermidis
Staph. aureus
Diphtheroids
Streptoccocci
P. aeruginosa
Anaerobes
Candida torulopsis
Pityrosporum

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Interaksi Host - Bakteri

DITENTUKAN OLEH KESEIMBANGAN

VIRULENSI BAKTERI

DAYA TAHAN TUBUH

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Interaksi Host dan Mikroba
• Sehari-hari kita:
– menelan ribuan mikroorganisme pada makanan yang
kita makan
– menghirup ratusan ribu mikroorganisme di udara yang
kita hirup
– memiliki mikroorganisme menempel pada kita
kemanapun kita pergi
 Sebagian besar tidak memiliki efek buruk pada kita
 Kita dilindungi secara “bersahabat" oleh flora residen
(menetap) yang ditemukan di seluruh tubuh kita
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• Interaksi ini disebut simbiosis, yang berarti
hidup bersama
– mutualisme
– komensalisme
– parasitisme

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Mutualisme
• Kedua belah pihak mendapat keuntungan
– E. coli mensintesis vitamin K dalam usus
– Dengan imbal balik usus besar memberikan
nutrisi yang dibutuhkan untuk kelangsungan
hidupnya
E. coli

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Komensalisme

• Salah satu diuntungkan dan yang lain tidak


berpengaruh terhadap hubungan tipe ini
– Banyak mikroorganisme sebagai flora normal
seperti pada mata, telinga, dan genitalia
eksterna

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Parasitisme
• Satu organisme mendapat keuntungan
dengan mengorbankan pihak lainnya
– Semua yang patogen adalah parasit ( merugikan)

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• flora normal juga dapat menimbulkan
penyakit pada kondisi tertentu.
ex:
-Streptococcus viridans dapat menyebabkan
penyakit :Subacute bacterial endocarditis.
-Bacteroides sp yang normal terdapat di kolon
dapat menyebabkan peritonitis mengikuti
suatu trauma.
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Asal Mula Mikrobiota Manusia
 Sampai waktu akan dilahirkan, janin tidak
mengandung mikroorganisme.
 janin manusia mula-mula memperoleh
mikroorganisme ketika lewat sepanjang
saluran lahir melalui kontak permukaan,
penelanan atau penghisapan
 Setiap bagian tubuh manusia, dengan kondisi
lingkungan yang khusus, dihuni berbagai
macam mikroorganisme tertentu.
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Berdasarkan bentuk dan sifat kehadirannya
dapat digolongkan menjadi 2 jenis,

I. Mikroorganisme tetap/normal (resident flora/


indigenous)
 yaitu mikroorganisme tertentu yang biasanya ditemukan
pada bagian tubuh tertentu dan pada usia tertentu.
 Keberadaan nya selalu tetap, jika ada perubahan akan
kembali seperti semula. ---merupakan organisme
komensal.
 Ada yang bersifat mutualisme.: mendapatkan makanan
dari sekresi dan produk-produk buangan tubuh manusia,
dan tubuh memperoleh vitamin atau zat hasil sintesis
dari flora normal

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2. Mikroorganisme sementara (transient flora)
 mikroorganisme nonpatogen atau potensial patogen
yang berada di kulit dan selaput lendir/mukosa selama
kurun waktu beberapa jam, hari, atau minggu.
 Keberadaan mikroorganisme ini ada secara tiba-tiba
(tidak tetap) dapat disebabkan oleh pengaruh
lingkungan, tidak menimbulkan penyakit .
 Flora sementara biasanya sedikit.
 Jika flora residen berubah, maka mikroba ini akan
melakukan kolonisasi, berbiak dan menimbulkan
penyakit.

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 Flora yang menetap diselaput lendir dan kulit dapat
mencegah kolonialisasi oleh bakteri patogen (
bacterial interference) dan mencegah penyakit
akibat gangguan bakteri melalui :
1. kompetisi pada reseptor atau tempat pengikatan
pada sel penjamu,
2. kompetisi untuk zat makanan,
3. penghambatan oleh produk metabolik atau racun,
4. penghambatan oleh zat antibiotik atau
bakteriosin (bacteriocins).

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Figure 27.1

Microbial Mucus
cells

Epithelial
cell

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© 2012 Pearson Education, Inc.
Normal Microflora of the Skin
• The skin is generally a dry, acid
environment that does not support the
growth of most microorganisms

• Most areas (e.g., sweat glands) are readily


colonized by gram-positive bacteria and
other normal flora of the skin

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© 2012 Pearson Education, Inc.
Figure 27.2

Hair

Epidermis
Dead
layer

Duct Dermis
Sebaceous
gland Apocrine
sweat gland
Subcutaneous
tissue
Hair follicle

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© 2012 Pearson Education, Inc.
Normal Microflora of the Skin

• The Skin Microflora


– Composition is influenced by
• Environmental factors (e.g., weather)
• Host factors (e.g., age, personal hygiene)

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© 2012 Pearson Education, Inc.
SKIN

• The epidermis, or outer surface layer of the


skin, covers a connective tissue layer, called
dermis or first line of defense

• Does not support survival of most organisms

• Although cuts, abrasion, or burns can allow


microbes to penetrate this layer, it is normally
impermeable to microorganisms
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The Major microbial symbionts found on or the skin of humans

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Several factor are responsible for
discouraging microbial growth on the skin :

1. Dryness
• the relatively dry surface of skin is to inhibitory
to microbial growth
• When allowed to dry, many bacteria enter a
dormant condition; some species die in a matter
of hours
• Moister areas (axillae, perineum, between toes,
scalp) have much larger populations e.g.
coagulase negative Staphylococci, S.aureus,
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• Gram-negative bacilli do not permanently
colonize few resident organisms (except
Acinetobacter sp.) because skin is too dry

2. Low pH
• Skin has normal pH : 3 – 5
• This low pH can inhibit the growth of many
kinds of microorganism

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3. Inhibitory substances
• Several bactericidal or bacteriostatic compound
occur on the skin.
• Such as :
• Sweat glands, secrete lysozyme, and enzyme
that destroys the peptidoglycan of bacterial cell
walls
• Secrete complex lipids, which may be partially
degraded by bacteria : Propionibacterium acnes
to produce long- chain fatty acid such as oleic acid,
that are highly inhibitory to other bacteria

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• Neither profuse sweating, nor washing and bathing
can eliminate or significantly modify the normal
resident flora.

• The number of superficial microorganisms may be


diminished by vigorous daily scrubbing with soap
containing hexachlorophene or other disinfectants.

• Anaerobes and aerobic bacteria often join to form


synergistic infections (gangrene, necrotizing, fasciitis,
cellulitis of skin and soft tissue. It is usually difficult to
pinpoint one specific organism as being responsible
for the progressive lession
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The main differences between the cell wall of Gram
positive and Gram negative bacteria are as follow :

A. Gram positive bacteria


- the cell wall contains a large amount of peptidoglycan
(20-80 nm) and teichoic acids which consist of polymers
of ribitol phosphate and, or, glycerol phosphate

B. Gram negative bacteria


- the cell wall contains only a small amount of peptidoglycan
(5-10 nm)

- The outer layer of the cell wall, however, contains toxic


lipopolysaccharide molecules, referred to as endotoxin.

- The lipid A part of these molecules is highly toxic


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Gram-positive cell wall Gram-negative cell wall

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If the organism breach the stratum corneum

the host defenses are mobilized

the epidermal Langerhans’ cells elaborate


cytokines, neutrophiles are attracted to the
site of invasion, and complement is activated
via the alternative pathway

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Microbial disease of the skin may
result from any of three lines of
attack

• Breach of intact skin


• Skin manifestations of systemic infections
• Toxin-mediated skin damage

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Slide preparation
From liquid media From solid media

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Gram stain

Gently stain with crystal violet Gently stain wash off the stain Gently apply Gram’s iodine for 45 –
For 5 minutes With tap water 60 seconds

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Counterstain with carbol fukhsin for Gently wash off the carbol fukhsin 42
1 – 2 minutes with tap water
Demonstration :

Vibrio sp.

Staphylococcus sp.
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Escherichia coli

B. subtilis

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Advantages
of the normal flora on the skin

• Skin bacteria produce fatty acids : which


discourage other species from invading

• excretion of lysozyme by sweat glands

• Desquamation of epithelium

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Disadvantages
of the normal flora on the skin

• When organisms from perianal skin ascend


the urethra and cause urinary tract infection

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Asepsis
• The exclusion of pathogenic and potentially
pathogenic microorganismsmto avoid infection:

1. Medical asepsis (hospital personnel, patients,


hospital environment as free as possible from
infectious microorganisms)

2. Surgical asepsis (all instruments, gloves, &


other items that come into contact with a patient
must be sterile)

• Aseptic technique:
practices designed to prevent contamination
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Hand Washing

• The single most important measure to


reduce the risks of transmitting
microorganisms from person to another or
from one site to another on the same
patient

• Washing hands as promptly and thoroughly


as possible between patient contacts and
after contact with blood, body fluids,
secretions, and equipment or articles
contaminated by them is an important
component of infection control and
isolation precautions.
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Gram-negative
rods are not
usually part of the
resident skin flora
except in moist
environment, but
are readily carried
on hands and can
be transferred
from a source to
a susceptible
patient
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 Supresi flora normal akan menimbulkan tempat
kosong yang cenderung akan ditempati oleh
mikroorganisme dari lingkungan atau tempat lain
pada tubuh. Beberapa bakteri bersifat oportunis dan
bisa menjadi patogen
 Flora normal biasanya ditemukan di bagian-bagian
tubuh manusia yang kontak langsung dengan
lingkungan misalnya kulit, hidung, mulut, usus,
saluran urogenital, mata, dan telinga.
 Organ-organ dan jaringan biasanya steril.
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Mikroflora normal pada
kulit,hidung,telinga,konjungtiva
• Bakteri patogen yang akan menginfeksi
kulit harus mampu bersaing dengan
mikroflora normal yang ada untuk
mendapatkan tempat kolonisasi serta
nutrien untuk tumbuh dan berkembang.
• ada sekitar 103-104
mikroorganisme/cm2 yang kebanyakan
terletak pada stratum korneum.
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• Jumlah mikroorganisme kulit dapat
berkurang dengan desinfektan, namun
flora secara cepat muncul kembali dari
kelenjar sebasea dan keringat
• Staphylococcus epidermidis yang
bersifat nonpatogen pada kulit namun
dapat menimbulkan penyakit saat
mencapai tempat-tempat tertentu seperti
katup jantung buatan dan sendi
prostetik (sendi buatan).

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 Staphylococcus aureus, dapat berkolonisasi
transien di kulit, tapi dapat menetap pada
rongga hidung ( nasopharyng)
 Oropharyng dihuni sejumlah besar S.
aureus dan S. epidermidis dan Strep α-
hemolitik ( Streptococcus viridans).
 Flora liang telinga luar = flora kulit
 Liang telinga tengah dan dalam biasanya
steril
 Flora konjungtiva dalam keadaan normal
dikendalikan oleh aliran air mata, yang
mengandung lisozim.

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