22.1 Anatomy and normal microbiota of the respiratory tract  (Page 3/12)

Normal microbiota of the respiratory system

The upper respiratory tract contains an abundant and diverse microbiota . The nasal passages and sinuses are primarily colonized by members of the Firmicutes , Actinobacteria , and Proteobacteria . The most common bacteria identified include Staphylococcus epidermidis , viridans group streptococci (VGS), Corynebacterium spp. (diphtheroids), Propionibacterium spp., and Haemophilus spp. The oropharynx includes many of the same isolates as the nose and sinuses, with the addition of variable numbers of bacteria like species of Prevotella , Fusobacterium , Moraxella , and Eikenella , as well as some Candida fungal isolates. In addition, many healthy humans asymptomatically carry potential pathogens in the upper respiratory tract. As much as 20% of the population carry Staphylococcus aureus in their nostrils. J. Kluytmans et al. “Nasal Carriage of Staphylococcus aureus : Epidemiology, Underlying Mechanisms, and Associated Risks.” Clinical Microbiology Reviews 10 no. 3 (1997):505–520. The pharynx, too, can be colonized with pathogenic strains of Streptococcus , Haemophilus , and Neisseria .

The lower respiratory tract, by contrast, is scantily populated with microbes. Of the organisms identified in the lower respiratory tract, species of Pseudomonas , Streptococcus , Prevotella , Fusobacterium , and Veillonella are the most common. It is not clear at this time if these small populations of bacteria constitute a normal microbiota or if they are transients.

Many members of the respiratory system’s normal microbiota are opportunistic pathogens. To proliferate and cause host damage, they first must overcome the immune defenses of respiratory tissues. Many mucosal pathogens produce virulence factors such as adhesin s that mediate attachment to host epithelial cells, or polysaccharide capsules that allow microbes to evade phagocytosis. The endotoxin s of gram-negative bacteria can stimulate a strong inflammatory response that damages respiratory cells. Other pathogens produce exotoxin s, and still others have the ability to survive within the host cells. Once an infection of the respiratory tract is established, it tends to impair the mucociliary escalator , limiting the body’s ability to expel the invading microbes, thus making it easier for pathogens to multiply and spread.

Vaccines have been developed for many of the most serious bacterial and viral pathogens. Several of the most important respiratory pathogens and their vaccines, if available, are summarized in [link] . Components of these vaccines will be explained later in the chapter.