Noma is a rapidly progressive, polymicrobial, often gangrenous infection of the mouth or genitals.
Contents
1Signs and symptoms
2Causes
3Treatment
4Prognosis
5Society and culture
6See also
7References
8Further reading
9External links
Signs and symptoms
Noma (sketch from 1836)
The mucous membranes of the mouth develop ulcers, and rapid, painless tissue degeneration ensues, which can degrade tissues of the bones in the face.[2]
In a condition sometimes called noma pudendi, noma can also cause tissue damage to the genitals.
Causes
Fusobacterium necrophorum and Prevotella intermedia are important bacterial pathogens in this disease process, interacting with one or more other bacterial organisms (such as Borrelia vincentii, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Staphylococcus aureus, and certain species of nonhemolytic Streptococcus).[3] Note that there is no known cause; the following list is only an estimation of possibilities.
It is often reported as a sequela to acute necrotising ulcerative gingivitis. Predisposing factors include:[4][5]
malnutrition (particularly A-and B-vitamins) or dehydration
poor hygiene, particularly oral
unsafe drinking water
proximity to unkempt livestock
recent illness
an immunodeficiency disease, including AIDS
measles
smoking
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 improvements 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.[6] The disease and treatments were studied by Berthold Epstein, a Czech physician and forced-labor prisoner who had recommended the study under Josef Mengele's direction.[6]
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 oral and maxillofacial surgery or reconstructive plastic surgery to repair. Reconstruction is usually very challenging and should be delayed until full recovery (usually about one year following initial intervention).[7]
Prognosis
The disease is associated with high morbidity and mortality[8] and affects mainly children in the poorest countries of Africa. Children in Asia and some countries of South America are also highly affected. Most children who get the disease are between the ages of two and six years old.[9] The WHO estimates that 500,000 people are affected, and that 140,000 new cases are reported each year.[10] The mortality rate is approximately 90 percent.[1]
Society and culture
Children and other noma survivors in Africa are helped by a few international charitable organizations, such as Facing Africa, a UK registered charity that helps affected Ethiopian, and Swiss charity Winds of Hope.[11] There is one dedicated noma hospital in Nigeria, the Noma Children Hospital Sokoto, staffed by resident and visiting medical teams. In other countries, such as Ethiopia, international charities work in collaboration with the local health care system to provide complex reconstructive surgery which can give back facial functions such as eating, speaking and smiling. Teams of volunteer medics coming from abroad are often needed to support the local capacity to address the most severe cases, which can be extremely challenging even for senior maxillofacial surgeons.[12] On 10 June 2010 the work of such volunteer surgeons was featured in a UK BBC Two documentary presented by Ben Fogle, Make Me a New Face: Hope for Africa's Hidden Children. Recently a case was reported from Nepal where the 19-year-old girl received free surgical treatment in Chitwan Medical College, Bharatpur; the team of surgeons was led by Dr. Sushil Subedi, Oral and Maxillofacial surgeon and the head of Department.[13][14]
See also
Necrotizing fasciitis
References
^ abMarck, KW (2003). "A history of noma, the "Face of Poverty" (abstract)". Plast Reconstr Surg. 111 (5): 1702–7. doi:10.1097/01.PRS.0000055445.84307.3C. PMID 12655218.
^"AllRefer Health - Noma (Cancrum Oris, Gangrenous Stomatitis)". Archived from the original on 2007-05-28. Retrieved 2007-07-12.
^Neville, Brad. Oral and Maxillofacial Pathology (3rd ed.). Saunders Book Company. pp. 062008. 5.11.
^Enwonwu CO (2006). "Noma--the ulcer of extreme poverty". N. Engl. J. Med. 354 (3): 221–4. doi:10.1056/NEJMp058193. PMID 16421362.
^ abLifton, Robert Jay (1986). The Nazi Doctors: Medical Killing and Psychological Genocide. Basic Books. p. 361. ISBN 978-0-465-04905-9.
^Neville, Brad. Oral and Maxillofacial Pathology, 3rd Ed. Saunders Book Company, 062008. 5.11.2
^Barmes DE, Enwonwu CO, Leclercq MH, Bourgeois D, Falkler WA (1997). "The need for action against oro-facial gangrene (noma)". Trop Med Int Health. 2 (12): 1111–1114. doi:10.1046/j.1365-3156.1997.d01-220.x.
^"The European Noma-Network". Retrieved 2007-07-12.
^Bourgeois DM, Leclercq MH (1999). "The World Health Organization initiative on noma". Oral Dis. 5 (2): 172–174. doi:10.1111/j.1601-0825.1999.tb00085.x.
^Fondation Winds of Hope
^Medical care at Project Harar
^"Make Me a New Face: Hope for Africa's Hidden Children". BBC. June 2010. Retrieved January 13, 2016.
^Fogle, Ben (July 6, 2010). "Ben's Documentary on Noma - BBC2". BenFogle.com. Retrieved January 13, 2010.
Further reading
Tonna, J. E.; Lewin, M. R.; Mensh, B. (2010). Franco-Paredes, Carlos, ed. "A Case and Review of Noma". PLoS Neglected Tropical Diseases. 4 (12): e869. doi:10.1371/journal.pntd.0000869. PMC 3006140. PMID 21200428.
The Surgical Treatment of noma by Kurt Boss and Klaas Marck. ISBN 978-90-71736-31-5
Pretreatment Serum Carbohydrate Antigen 19-9 Concentration Is a Predictor of Survival of Patients Who Have Undergone Curative Resection of Stage IV Rectal Cancer.
Miki H1, Akiyoshi T, Ogura A, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Noma H, Saiura A, Fukunaga Y, Ueno M.
For other uses of "Noma", see Noma (disambiguation). Noma, also known as cancrum oris or gangrenous stomatitis, is a gangrenous disease leading to tissue destruction of the face, especially the mouth and cheek.
16 Nov 2012 ... Noma is a severe disfiguring gangrene of the mouth and face that starts as a gingival ulcer and spreads rapidly through the tissues of the mouth and face. Unlike other infectious processes of the face, which may progress ...
