As spore-forming bacteria, bacilli make spores that release toxins. Ogawa H, Kitsios GD, Iwata M, Terasawa T. Falsey AR, Becker KL, Swinburne AJ, et al. A persons microbiota is fully established by about 3 years of age. Organisms identified by MALDI-TOF as S mitis (oralis), alone or together with other NRF, predominated (14 of 31 [45.2%] cases; Figure 2A); the median cfu/mL of these streptococci was 5106. %|X%T'y4r*U*xaKd_? Streptococci are divided into the following categories: When gram-positive bacteria are shaped like rods, theyre known as bacilli. But the average pulse rate is between 60 and 80 beats per min. Cough, dyspnea, wheezing, chest tightness, chest heaviness, chest pain, gasping, snoring, stridor, sputum production, heartburn, hemoptysis, fever, ca ) Ventilator-Associated Pneumonia and The Role of Normal Respiratory Flora Patients are at most at risk of developing ventilator-associated pneumonia (VAP) in the first 48 hours after an endotracheal tube has been placed. Although the bacterium most commonly associated with the intestines is E. coli, it is actually not the most numerous in the intestine. Gram positive vs. gram negative. (B) Haemophilus pneumonia. aureus is most often found in the nose of those individuals who carry it in their normal flora. few polys Normal flora can be found in many sites of the human body including the skin (especially the moist areas, such as the groin and between the toes), respiratory tract (particularly the nose), urinary tract . In an additional 19.1% of patients whose sputum yielded RBP, coinfection with NRF may have played a contributory role; mixed bacterial infections will be discussed in detail below. Patients (1) whose sputum contained 106 cfu/mL of organism(s) that are not generally regarded as a cause of pneumonia, for example, Streptococcus mitis and other viridans streptococci, Corynebacteria, Lactobacillus, or Candida sp and (2) in whom the reading of the sputum Gram stain was consistent with these culture results were categorized as having pneumonia due to NRF. Also, a respiratory culture looks for bacteria and fungus, whereas . We hypothesized that aspiration of normal respiratory flora (NRF) might also cause CAP. (2014). It is often contrasted with the term "fauna," which is used to describe the animal life of the same particular area. Sputum Gram stain and culture are indicated for all patients with hospital-acquired pneumonia. It helps by replenishing the bodys fluid levels and preventing dehydration. The intensity of the inflammatory response in the lungs, as measured by median WBC per milliliter in liquefied sputum, was slightly greater in pneumonia due to recognized pathogens than pneumonia due to NRF (1.7107 vs 1.0107 per mL, P=.04), and far greater when all bacterial pneumonias were compared with viral pneumonias (1.5107 vs 3.2106, P=.01). <>>> The appropriate antitoxin depends on the specific toxin. Streptococcus mitis shares molecular characteristics of S pneumoniae, including the capacity to make capsule, and ample evidence shows their capacity to cause serious infection in humans [25, 32, 33]. Infants born by caesarean section have significantly different microbiota than those born vaginally. Using quantitative PCR, Gadsby et al [7] demonstrated an RBP in 87% of CAP; these authors did not use primers that could detect NRF. Because of this difference, gram-negative bacteria are harder to kill. Delay in sputum processing with possible overgrowth of oropharyngeal flora. Delmars Guide to Laboratory and Diagnostic Tests. In 79 of 120 (65.8%) cases, antibiotics had been given for 2 hours. To minimize selection bias, on each day selected for study, we included every patient who met inclusion criteria. The symptoms of pneumonia can range from moderate to life-threatening, and include: Children under the age of 5, older adults over the age of 65, and people with a weak immune system are at heightened risk of developing pneumonia. While there are more than 100 pathogenic gram-positive bacteria, the most notable species include: Staphylococci are commonly responsible for bacterial infections. Often, erythromycin is prescribed to people who are allergic to penicillin. Your doctor can use the results to help diagnose the cause of respiratory symptoms. One or more RBPs were identified in sputum from 68 of 120 (56.7%) patients (Table 1); representative Gram stains and quantitative bacteriologic results are shown in Figure 1. Depending on how anthrax is spread, it can cause a variety of symptoms. The nostrils are always densely populated, mostly with Staphylococcus epidermidis and corynebacteria, and rarely (in about 20% of the general population) with Staphylococcus aureus. Of the 66 nondiagnostic specimens, 39 (59%) contained mixed flora. Your Microbiome, Your Health, Broadening the Microbiome: Fungi in Inflammatory Bowel Diseases (IBD), Privacy Policy, Terms of Use and State Disclosures. Lack of normal flora also makes animals more susceptible to infection with a variety of pathogens, particularly those that infect the GI tract. COMMENSAL FLORA in sputum | HealthTap Online Doctor Promote biofilm production so that more organisms can attach and proliferate. websites owned and operated by ASM ("ASM Web Sites") and other sources. Generally, fluid management is required to treat conditions caused by toxins. "Mixed upper respiratory tract flora" is normal and does not usually need treatment. Quantitative culture yielded 1.6107 Streptococcus pneumoniae per milliliter of sputum (right); the figure shows colony-forming units in 0.01-mL aliquots of sputum that had been diluted by 101 to 104 after an initial 1:2 dilution with 4% N-acetyl cysteine in 0.9% saline. The infection is spread from person to person through coughing or sneezing. Academic Pulmonary Sleep Medicine Physician Opportunity in Scenic Central Pennsylvania, MEDICAL MICROBIOLOGY AND CLINICAL LABORATORY MEDICINE PHYSICIAN, CLINICAL CHEMISTRY LABORATORY MEDICINE PHYSICIAN, Recognized bacterial infection+viral coinfection, Normal respiratory flora+viral coinfection, Copyright 2023 Infectious Diseases Society of America. Thorsteinsson SB, Musher DM, Fagan T. Musher DM, Kubitschek KR, Crennan J, Baughn RE. Not surprisingly, NRF appeared to be less virulent than RBPs. normal flora Microorganisms including bacteria, protozoa, and fungi that are found on or in specific areas of the body. To be safe, you should have someone drive you home afterward. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. All samples that had large numbers of Candida were polymicrobial. Our website services, content, and products are for informational purposes only. The American Society for Microbiology K&WS\cP2k:^x,d>.ca: This removes secretions and oral plaque, which may contaminate the sample. Normal Flora of the Respiratory Tract: The upper respiratory tract (nasopharynx) is colonized by a large number of bacterial species. The American Society for Microbiology, Growth of these organisms from a culture of the oropharynx/nasopharynx is of no significance. Pneumonia caused by pathogens that do not grow on standard sputum culture media (eg, atypical organisms, viruses, anaerobes). It is also known as phlegm and, because of its thickness, can contain infectious germs. Sputum Culture: MedlinePlus Medical Test this information and the choices you have about how we use such information. Is respiratory allergy one of the many reasons that can cause mild chest discomfort? Ventilation involves placing an endotracheal tube down the windpipe to deliver oxygen directly to the lungs, which is a life-saving procedure but not one without risks. Many respiratory pathogens live normally in the host without causing disease. Now a new study presents an innovative approach to addressing the issue of antibiotic resistance through the development of shape-shifting, Like Lyme disease, anaplasmosis is spread by tick bites. aOne case each of Pasteurella multocida and Mycobacterium avium/intracellulare. Collecting the first sample before any antibiotic or antimicrobial therapy is initiated is necessary. Abbreviations: NRF, normal respiratory flora; RBP, recognized bacterial pathogen. Etiologic Role of Normal Respiratory Flora in 120 Cases of Community-Acquired Pneumonia. A coinfecting respiratory virus was documented in 10 cases (8.3% of the total 120 cases and 32% of patients infected with NRF). 4 0 obj To perform a bronchoscopy, your doctor or nurse will spray a local anesthetic into your nose and throat. 2nd edition. Though both groups of bacteria can cause disease, they require different treatments. Please confirm that you would like to log out of Medscape. For many reasons, mechanically ventilated patients are especially susceptible to developing pneumonia. We recently described a series of cases of pneumonia due to Corynebacterium sp [27], and Garg et al [28] documented bacteremia due to viridans streptococci and Corynebacteria in patients with influenza virus pneumonia. A sputum Grams stain is a laboratory test that allows your doctor to diagnose a bacterial infection in your respiratory tract. Kilian M, Riley DR, Jensen A, et al. The explanation for this difference is that the present study included only patients who expectorated a high-quality sputum and who had not received antibiotics for >16 hours; in fact, in two thirds of cases, antibiotics had been given for 2 hours. Sputum culture is used to diagnose pneumonia, bronchiectasis, bronchitis, or pulmonary abscess. A sputum culture is a test that checks for bacteria or another type of organism that may be causing an infection in your lungs or the airways leading to the lungs. Humans can get anthrax through inhalation or contact with infected animals. That is a 150-fold difference between the human and bacterial genetic contribution. stream resident or nonpathogenic micro-organisms, specifically bacteria, that constitute what is known as the normal flora of the throat. In a medical setting, a doctor can send a sample of your blood, urine, or tissue to a lab for Gram stain testing. Resp rate is 16 to 18 breaths per min. In total (Table 4), RBPs caused CAP in 68 (56.7%) of 120 patients; 14 (20.6%) were coinfected with a respiratory virus. Additionally, its used in combination with other treatments. West Sussex, UK: Wiley-Blackwell. Majd Ibrahim, MD Chief Medical Resident, Department of Internal Medicine, University of Illinois College of Medicine at Peoria These studies have all reported coinfections only with RBPs. Serious respiratory infections are a risk for all hospitalized patients, but are particularly common in the intensive care unit (ICU). Pseudomonas aeruginosa is not commonly part of the microbiota of the respiratory tract, but it can become a colonizer in patients who have been admitted to the hospital for an extended period of time. Daniela Hermelin, MD Assistant Professor of Pathology, St Louis University School of Medicine; Associate Director of Transfusion Medicine, Director of Clinical Apheresis, St Louis University Hospital A nurse will help you cough up sputum. 2 doctor answers 4 doctors weighed in Share It can be particularly serious for older adults and others with weakened immune systems. Identifying one of these organisms as the cause of infection must be done in the context of clinical signs and symptoms of pneumonia*. One-milliliter micropipetters, with the tips cut to enlarge the orifice, were used to draw up 0.51 mL purulent sputum that was then liquefied with 2% N-acetyl cysteine and diluted serially; 0.01 mL aliquots were streaked onto blood and chocolate agar and incubated under 5% CO2. Its the most common preliminary test beyond a chest X-ray for pneumonia and other respiratory infections, and can help your doctor promptly prescribe a treatment plan. Thus, in these 120 cases of CAP, 1 recognized bacterial and/or viral pathogen(s) was/were identified in 94 (78.3%) cases. These bacilli are subdivided based on their need for oxygen. Generally, they have the following characteristics: Gram-positive and gram-negative bacteria have different structures. Strep throat is an infection that affects the throat and tonsils. Common bacteria likely to cause pneumonias include: Streptococcus pneumoniae, Haemophilus influenza and Moraxella catarrhalis. (C) Staphylococcal pneumonia. endobj [QxMD MEDLINE Link]. Symptoms include diarrhea and abdominal cramps that last for less than 24 hours. Other inhabitants of the mouth and upper respiratory tract include bacteria in the genera Neisseria and Haemophilus. Keep coughing up sputum until the cup is filled to the marker, which should equal approximately 1 teaspoon. It typically occurs after taking antibiotics. Gram-positive bacilli are further categorized based on their ability to make spores. Most cases are caused by the following species. Gram stain showed many Gram-positive rods and yeast, many of which are cell-associated. Sputum, also known as phlegm, is a thick type of mucus made in your lungs. This will help your body make more sputum. Ieven M, Coenen S, Loens K, et al. The immune system is underdeveloped. This difference in the rate of viral coinfection was not significant (P=.26). Haemophilus influenzae, or H. influenzae, is a kind of bacteria. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. % Youll be monitored until youre fully awake. We avoid using tertiary references. Abbreviations: NRF, normal respiratory flora. 2 0 obj Cultures should be performed rapidly after collection, ideally within 2 hours; otherwise, the sample should be saved at 4C. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Recent studies using molecular techniques also have recognized multiple bacterial pathogens in high-quality sputum samples [6, 7, 36]. 200 (7):e45-e67. There are very few risks associated with collecting a sample of your sputum. 1r`HpQ 8 y/#+-pDmqvOWsZc-|p.Vu=>exBQ'&M,?~L+TE {nZkP'Dowmskhwo1"K>x Patients infected with RBPs whose sputum also contained >106 cfu/mL NRF will be discussed below but, to follow convention, were categorized under RBP. Read More Created for people with ongoing healthcare needs but benefits everyone. For every sputum categorized as high quality (20 white blood cells [WBCs] per epithelial cell), a higher standard than that usually accepted [11], electronic medical records were reviewed to identify patients who had been admitted from the community with 2 of the following findings: (1) fever, increased cough, sputum production or shortness of breath, pleuritic chest pain, rales or confusion; (2) on imaging had a newly recognized pulmonary infiltrate; and (3) submitted a sputum sample within 16 hours of antibiotics being begun. Specimen collection after antibiotic therapy has been initiated may result in inhibited or no growth of organisms. Streptococcus pneumoniae is a normal colonizer of the respiratory tract, yet it is the leading cause of pneumonia mortality globally. An additional 13 of 68 (19.1%) patients with RBP pneumonia had 1106 cfu of NRF per mL sputum (Figure 2E); although, in these cases, NRF may have contributed to infection, we followed convention by listing them in Tables 1, 2, and 4 as pneumonia due to RBP (see Discussion). Learn what its used for and what to expect. The CCI for all patients with NRF pneumonia was 6.6 vs 5.3 for those with RBP pneumonia and 4.2 for those with viral pneumonia alone (P=.01). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. A child who develops a viral upper respiratory tract infection while colonized may develop acute otitis media or sinusitis. It should be noted on the requisition as being aerosol induced. Share cases and questions with Physicians on Medscape consult. The presence of normal upper respiratory tract flora should be expected in sputum culture. bIncludes 2 cases in which polymerase chain reaction (PCR) for influenza virus and respiratory syncytial virus were negative but the full viral respiratory PCR was not done. The test is sometimes called a Grams stain of sputum. 13.1: Normal Flora of the Human Body - Biology LibreTexts Your doctor may order a sputum Grams stain to help identify the cause of pneumonia. Accessibility StatementFor more information contact us atinfo@libretexts.org. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Although S. aureus can occasionally be found on the skin, it is more commonly found in the nose in those people that carry it in their normal flora. It is shifts in the proportions of these groups of microbes that are typically studied when investigating the role of normal flora on human health. The reading of Gram stain by the microbiology laboratory was mixed Gram-positive organisms, and the final culture report was normal respiratory flora. (C) Pneumonia due to Candida glabrata. Normally, they exist on our skin and mucous membranes without causing problems. Patient was suspected to have intermittent aspiration. Although both Staphylococci and Streptococci are Gram-positive cocci, unlike the Staphylococci the Streptococci are catalase-negative, consistent with the low-oxygen environment of the mouth. Fine, beaded Gram-positive filamentous bacteria did not grow in aerobic cultures. Do not pool multiple samples in a 24-hr period. Intensive studies have failed to identify an etiologic agent in >50% cases of community-acquired pneumonia (CAP). File TM Jr, Low DE, Eckburg PB, et al. They are present either throughout the life of for short period of time. This The origin of organisms that are introduced into the sinuses and may eventually cause sinusitis is the nasal cavity. These criteria were used to stratify pneumonia into 6 etiologic groups: pneumonia due to (1) RBPs; (2) respiratory viruses; (3) coinfection by RBPs and a respiratory virus; (4) NRF; (5) coinfection by NRF and a respiratory virus; and (6) cause undetermined. What Temperature Kills Bacteria in Water and Food? It causes: Streptococci bacteria are also common pathogenic bacteria. Learn how to spot and prevent anaplasmosis, a bacterial infection from the same ticks that spread Lyme disease. The 2007 Infectious Diseases Society of America and American Thoracic Society (IDSA/ATS) consensus guidelines on community-acquired pneumonia (CAP) in adults recommend expectorated sputum specimens for hospitalized patients with signs and symptoms of pneumonia and any of the following conditions: Erythromycin is in a class of antibiotics known as macrolides, which also includes the better-known azithromycin and clarithromycin. Because we were studying patients who were acutely infected, we focused on organisms that could be identified by culture and did not address the lung microbiome [38], although NRF are clearly an important component of that biome and the microbiome is a likely determinant of what organisms emerge to cause bacterial pneumonia. 2023 Healthline Media LLC. 1 0 obj The most common pathogens detected with a sputum culture are bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Klebsiella species. Chapot-Chartier MP, et al. One frequently cited statistic is that there are 10-100 times more bacterial than human cells in the body. If tuberculosis is suspected, an acid-fast stain should be performed immediately, and the sputum cultured on special media, which are incubated for at least 6 weeks. In particular, the presence of disease-causing bacteria. A respiratory virus (Table 1 and Figure 1D) was identified by PCR in 40 of 120 (33.3%) cases of CAP; in 14 cases, there was coinfection with a RBP. Clin Infect Dis. . A final reading of the sputum Gram stain was made by 2 observers without knowledge of the culture results, and agreement was reached by consensus. Gram stain shows characteristic pairs of Gram-positive cocci suggestive of S pneumoniae as well as long chains of streptococci that are not consistent with pneumococcus. If you log out, you will be required to enter your username and password the next time you visit. On days selected for study, Gram stains of all sputum samples that had been submitted to the clinical microbiology laboratory in the preceding 24 hours were examined. The most common bacteria of the skin flora are the Gram-positive, catalase positive cocci of the genera Staphylococcus and Micrococcus. A sputum culture helps lab technicians find the bacteria or fungi that might be making you sick. This means gram-positive and gram-negative bacteria require different treatments. This resident flora produces antigens that . (2019). %Tyk Sputum culture showed normal flora.gram stain showed mod.amt of gram positive and neg. The client should be instructed to avoid adding saliva or nasopharyngeal secretions to the sputum sample. These may include: B. cereus is a spore-forming bacterium thats found in the soil and some foods. Though gram-negative bacteria are harder to destroy, gram-positive bacteria can still cause problems. That said, in patients with confirmed VAP, P. aeruginosa is the most common bacterial cause. What does mixed flora, and many wbc's and few epithelial cells mean in a sputum culture? Privacy Policy sets forth the information we collect about you, how we use Potential conflicts of interest. Learn how to spot and prevent anaplasmosis, a bacterial infection from the same ticks that spread Lyme disease. Among NRF, organisms identified as Streptococcus mitis, which share many genetic features of S pneumoniae, predominated. Presence of normal upper respiratory flora will be reported. You can do this by boiling water and cooking food to the correct, Moraxella catarrhalis is a type of bacteria that can cause infections in children as well as adults who have weakened immune systems. Patients are at most at risk of developing ventilator-associated pneumonia (VAP) in the first 48 hours after an endotracheal tube has been placed. A respiratory virus alone was found in 16 of 120 (13.3%) patients. Equipment: Sterile, leak-proof container. As mentioned above, Staph. Staphylococcus aureus Infections - Merck Manuals Consumer Version [6], Severe obstructive or structural lung disease, Positive urine antigen test for pneumococcus, Positive urine antigen test for Legionella (special culture media for Legionella needed), Updated IDSA/ATS guidelines from 2019 state that, with regard to CAP, sputum culture is recommended not only for adult patients with severe disease but also for all adult inpatients who have received empirical treatment for methicillin-resistant S aureus and Pseudomonas aeruginosa. Determining the cause of your symptoms can help your doctor prescribe an appropriate treatment plan. This may help them diagnose a bacterial infection. Quantitative culture (data not shown ) yielded 2106 S aureus/mL. Huang WY, Lee MS, Lin LM, Liu YC. The present study, a single-center study with mainly male patients, was confined to patients who provided a high-quality expectorated sputum. (2015, February 24). There tends to be more bacteria present at this time and can help ensure accurate test results. This is a soft, narrow tube with a light and magnifying glass on the end. They might also give you a sedative to help you relax, or medication to put you to sleep, but general anesthesia isnt required. It leads to botulism, including: C. perfringens is usually associated with meat production and processing. They will place a thin layer of your sputum on a slide and allow it to dry. Part of normal upper respiratory tract microbiota. Learn how we can help 5.4k views Reviewed >2 years ago Thank Dr. Ryan Stanton agrees 1 thank Quantitative culture yielded 1.8106 S mitis (oralis) and 1.2106 H influenzae. endobj Medscape Education, Challenging Case in Nontuberculous Mycobacterial Lung Disease: Going the Distance for Your Patient, 20021941994-overviewDiseases & Conditions, encoded search term (Sputum Culture) and Sputum Culture, Bacteria Causing Rare Disease Melioidosis Found in the United States, CLL Treatment: More Infections Among Real-World Patients, Bilateral Endogenous Bacterial Endophthalmitis. An E.coli outbreak that has caused 29 illnesses and 9 hospitalizations in Michigan and Ohio is being investigated by the CDC. The remaining 39 (82%) patients with mixed flora received no antibiotic therapy and never developed pneumonia. The cellular contribution of microbes to the human body, however, is small compared to the genetic contribution. Write your name and the date on the label. The above represents the views of the author and does not necessarily reflect the opinion of the American Society for Microbiology. Bacterial coinfection was present in 24 of 40 (60%) cases with viral detection: 14 cases with RBP and 10 with NRF. Streptococcus pneumoniae was identified by screening for sensitivity to optochin and verified by bile solubility (if colony morphology was suspicious but the optochin test was negative, bile solubility was done anyway). S. mutans in particular plays a critical role in the formation of plaque and dental caries (cavities). Common contaminant from the upper respiratory tract (where this is a colonizing organism), but also a common cause of lower respiratory tract disease. An E.coli outbreak that has caused 29 illnesses and 9 hospitalizations in Michigan and Ohio is being investigated by the CDC. Normal Respiratory Flora as a Cause of Community-Acquired Pneumonia In a Gram stain test, these organisms yield a positive result. The skin and mucous membranes of the oral cavity, intestines, upper respiratory tract, and vagina have specific, permanent flora. Gram positive bacteria. Most illnesses require antibiotics that destroy or slow down the bacteria. Nearly one-third of adults are colonized with Staphylococcus aureus in their respiratory tracts. If the patient aspirates these bacteria, they may cause infection within the lungs. Typically, gram-negative organisms have the following the traits: The major difference is the outer lipid membrane. The hallmark trait of gram-positive bacteria is their structure. In this patient with pneumonia who was noted to be chronically aspirating, polymerase chain reaction was positive for influenza virus. What does mixed flora, many WBCs & few epithelial cells mean? - HealthTap It remains relatively stable through adulthood but begins to decline at about 65 years old (Figure \(\PageIndex{2}\)). Lessa FC, Milucky J, Rouphael NG, et al. Ramanan P, Barreto JN, Osmon DR, Tosh PK. 2007 Mar 1. Normal respiratory flora were found in 31 (25.8%) patients; 10 (32.2%) had a coinfecting respiratory virus. BSC 3271: Microbiology for Health Sciences Sp21 (Kagle), { "13.01:_Normal_Flora_of_the_Human_Body" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "13.02:_The_Role_of_Microbiota_in_Human_Physiology" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "13.03:_Pathogens_in_the_Normal_Flora" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "13.04:_Probiotics_and_Prebiotics" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, { "00:_Front_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "01:_Introduction" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "02:_Microbial_Structure" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "03:_Viruses" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "04:_Microbial_Diversity" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "05:_Principles_of_Microbial_Metabolism" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "06:_Fueling_and_Building_Cells" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "07:_Growth" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "08:_DNA_Replication" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "09:_Antimicrobial_Drugs" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "10:_Bacterial_Genetics" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "11:_Bacterial_Communities" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "12:_How_Microbes_Cause_Disease" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "13:_The_Human_Microbiota" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "14:_Immunology" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "15:_Selected_Pathogens" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()", "zz:_Back_Matter" : "property get [Map MindTouch.Deki.Logic.ExtensionProcessorQueryProvider+<>c__DisplayClass228_0.b__1]()" }, https://bio.libretexts.org/@app/auth/3/login?returnto=https%3A%2F%2Fbio.libretexts.org%2FCourses%2FMansfield_University_of_Pennsylvania%2FBSC_3271%253A_Microbiology_for_Health_Sciences_Sp21_(Kagle)%2F13%253A_The_Human_Microbiota%2F13.01%253A_Normal_Flora_of_the_Human_Body, \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}}}\) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash{#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)\(\newcommand{\AA}{\unicode[.8,0]{x212B}}\), 13.2: The Role of Microbiota in Human Physiology, Flora of the Mouth and Upper Respiratory Tract.

What Happens If You Fail Checkride, What Gas Stations Sell Vapes, Rocky Marciano Daughter, Articles W