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Noma (disease)
Specialty	Pediatrics, otorhinolaryngology, dentistry

Noma (from Greek numein: to devour) also known as cancrum oris or gangrenous stomatitis, is a gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek.

Causes

Noma is a rapidly progressive, polymicrobial, opportunistic infection that occurs during periods of compromised immune function. Fusobacterium necrophorum and Prevotella intermedia are thought to be key players in the process and interact with one or more other bacterial organisms (such as Borrelia vincentii, Porphyromonas gingivalis, Tannerella forsynthesis, Treponema denticola, Staphylococcus aureus, and nonhemolytic Streptococcus spp

The reported predisposing factors include

• Poverty
• Malnutrition or dehydration
• Poor oral hygiene
• Poor sanitation
• Unsafe drinking water
• Proximity to unkempt livestock
• Recent illness
• Malignancy
• An immunodeficiency disorder, including AIDS

In many cases a recent debilitating illness (usually measles and sometimes herpes simplex, varicella, scarlet fever, malaria, tuberculosis, gastroenteritis, and bronchopneumonia) precedes the appearance of noma as well as cancers such as leukemia . In many instances the infection begins as necrotizing ulcerative gingivitis (NUG). Early presentation is unclear as noma is often well progressed at initial presentation.

Noma, unlike most infections, is able to spread through anatomic barriers such as muscle.

In the developed world, noma has virtually disappeared except for an occasional case related to immunosuppressive conditions such as HIV infection, severe combined immunodeficiency syndrome, or intense immunosuppressive therapy . The World Health Organization (WHO) estimates the global yearly incidence to be approximately 140,000, of which 100,000 are between 1 and 7 years old and living in sub-Saharan Africa.

Presentation and prognosis

The mucous membranes of the mouth develop ulcers, and rapid, painless tissue degeneration ensues, which can degrade tissues of the bones in the face.

In a condition sometimes called noma pudendi, noma can also cause tissue damage to the genitals.

The disease is associated with high morbidity and mortality and mainly affects children under the age of twelve in the poorest countries of Africa. Children in Asia and some countries of South America are also affected. Most children who get the disease are between the ages of two and six years old. The WHO estimates that 500,000 people are affected, and that 100,000 new cases are reported each year.

Treatment

Known in antiquity to such physicians as Hippocrates and Galen, noma was once reported around the world, including Europe and the United States. With the improvement in hygiene and nutrition, noma has disappeared from industrialized countries since the 20th Century, except during World War II when it was endemic to Auschwitz and Belsen concentration camps. The disease and treatments were studied by Berthold Epstein, a Czech inmate physician directed to do so by Josef Mengele.

The progression of the disease can be halted with the use of antibiotics and improved nutrition; however, its physical effects are permanent and may require reconstructive plastic surgery to repair. Reconstruction is usually very challenging and it should be delayed until full recovery (usually about one year following initial intervention).

Despite the fact that more than 400,000 children are affected in Africa alone, there is only one noma hospital in all of Africa. Noma Children Hospital Sokoto is located in Nigeria and aside from the regular doctors, medical teams travel there to perform operations.{{fact{{ Without plastic surgery, the children's faces cannot be restored.

References

1. "noma" at Dorland's Medical Dictionary
2. Enwonwu CO (2006). "Noma--the ulcer of extreme poverty". N. Engl. J. Med. 354 (3): 221–4. doi:10.1056/NEJMp058193. PMID 16421362.
3. Enwonwu CO, Falkler WA, Phillips RS (2006). "Noma (cancrum oris)". Lancet. 368 (9530): 147–56. doi:10.1016/S0140-6736(06)69004-1. PMID 16829299.{{cite journal}}: CS1 maint: multiple names: authors list (link)
4. ^ Neville, Brad. Oral and Maxillofacial Pathology, 3rd Edition. Saunders Book Company, 062008. 5.11).
5. "AllRefer Health - Noma (Cancrum Oris, Gangrenous Stomatitis)". Retrieved 2007-07-12.
6. "The European Noma-Network". Retrieved 2007-07-12.
7. ^ Lifton, Robert Jay (1986). The Nazi Doctors: Medical Killing and Psychological Genocide. Basic Books. p. 361. ISBN 0465049052.
8. Neville, Brad. Oral and Maxillofacial Pathology, 3rd Edition. Saunders Book Company, 062008. 5.11.2

External links

• Graphic Noma Images
• All Refer Health article on Noma
• Project Harar
• The European Noma Network
• Les Enfants du Noma(French)
• Facing Africa
• The Geneva Study Group on Noma
• The Dutch Noma Foundation
• Bertrand Piccard Winds of Hope Foundation
• International Noma Federation
• Hilfsaktion Noma

• Gangrene
• Diseases and disorders