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At least 19 recordsLinked to original sources
PubMed1990

Noma and noma neonatorum.

Noma and noma neonatorum are rare gangrenous diseases that result in mutilating loss of tissue in the oronasal region. Noma usually occurs in patients between the ages of 2 and 5 years who are malnourished, have suffered a precedent illness, or are in some way immunodeficient, or all of the above. The gangrenous slough is thought to be caused by a mixed infection of oral bacterial pathogens. The disease may be fatal when it occurs in a severely debilitated patient. Noma neonatorum produces somewhat similar appearing lesions in the neonate. The infectious organism is usually Pseudomonas and the disease is generally accompanied by a life-threatening pseudomonal sepsis. Both diseases are rare in North America. Patients with noma and noma neonatorum were treated at the Children's Hospital and Medical Center, Seattle, WA. We present these cases and a literature review.

Bacterial Infections↗
PubMed1992

Noma neonatorum: an unusual case of noma involving a full-term neonate.

Noma neonatorum is a gangrenous process that occurs in the oral, nasal or anal area and occasionally the eyelids and scrotum of the newborn. The disease is caused by Pseudomonas aeruginosa and usually affects premature ill babies during the first few weeks of life. A full-term neonate with nasal and scrotal noma is uncommon and is therefore reported.

Humans↗
PubMed2003

A history of noma, the "Face of Poverty".

Noma (necrotizing ulcerative stomatitis, stomatitis gangrenosa, or cancrum oris) is a devastating orofacial gangrene that occurs mainly among children. The disease has a global yearly incidence of 140,000 cases and a mortality rate of approximately 90 percent. Patients who survive noma generally suffer from its sequelae, including serious facial disfigurement, trismus, oral incontinence, and speech problems. The medical history of noma indicates that the disease was already known in classical and medieval civilizations in Europe. In the sixteenth and seventeenth centuries, Dutch chirurgeons clearly described noma as a clinical entity and realized that the popular name "water canker" was not sufficient, because this quickly spreading ulceration in the faces of children was different from "cancer." In the eighteenth century, awareness that noma is related to poverty, malnutrition, and preceding diseases such as measles increased in northwestern Europe. In the first half of the nineteenth century, extensive surgical procedures were described for the treatment of the sequelae of noma. At the end of that century, noma gradually disappeared in the Western world because of economic progress, which gave the poorest in society the opportunity to feed their children sufficiently. Only in the twentieth century were effective drugs (sulfonamides and penicillin) against noma developed, as well as adequate surgical treatment for the sequelae of noma. These modes of treatment remain inaccessible for the many present-day victims of noma because of their extreme poverty. The only truly effective approach to the problem of noma throughout the world is prevention, namely, combating the extreme poverty with measures that lead to economic progress. In the meantime, medical doctors in the Western world should not forget their own history and ignore this global health problem; rather, they should face "the face of poverty" with the eyes of mercy and concern suited to their profession.

Child↗
PubMed1999

Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981-1993.

Oro-facial noma is an oral gangrene occurring in early childhood in extremely poor areas. As many as 70-90% of those with noma die, and to date, there is no satisfactory treatment to fight this disease. Within the context of the World Health Organization international program against noma, a 13-year retrospective study based on clinical records was carried out in Dakar, Senegal in an attempt to understand the epidemiology of noma. Between 1981 and 1993, 199 cases of noma were identified, among them; 36.7% were acute cases and 63.3% showed sequelae. Chronic sequelae of noma were seen in patients 2-41 years of age, but the acute phase of noma was found only in young children (77.7% in those 1-4 years of age, maximum age = 9 years, mean age +/- SD age = 3.4 +/- 1.9 years). A total of 73.1% of the cases with acute disease were reported in the Dakar, Diourbel and Kaolack regions during the dry season (57.0% of the cases). The lesions of progressive noma were localized mainly on the upper lip (42.4%) and the cheek (31.1%). A total of 96.9% of the patients with acute diseases were had poor general health with serious associated diseases; only 20.0% had a good vital prognosis. The development of epidemiologic surveillance programs for noma should be a public health priority in Senegal.

Adolescent↗
PubMed2003

An estimation of the incidence of noma in north-west Nigeria.

Noma (cancrum oris, stomatitis gangrenosa) is a quickly spreading orofacial gangrene in children, caused by a combination of malnutrition, debilitation because of concomitant diseases (measles) and intraoral infections. The global incidence of noma in the world is uncertain. By comparing large numbers of noma patients and cleft lip patients in a large referral hospital for these disorders in Sokoto, Nigeria, we calculated the incidence of noma in north-west Nigeria as 6.4 per 1000 children. Extrapolation of this incidence to the developing countries bordering the Sahara Desert (the noma belt of the world) gives an incidence of 25,600 for that region and a global incidence of 30,000-40,000. Noma is a good biological parameter of extreme poverty, and hence a global monitoring system for noma can be justified. Though economic progress is the most effective preventive measure against noma, medical prevention by vaccination programmes against measles should be enhanced as well.

Adolescent↗
PubMed1998

Necrotising infection of the orofacial tissues in neonates (noma neonatorum). Case report.

Noma neonatorum should be differentiated from noma, in that it is typically a disease of seriously ill premature infants whose birth weight was low, and is caused by Pseudomonas aerugenosa septicaemia. We know of only two case reports of noma neonatorum involving newborn infants born at full term, so we report here another case of noma neonatorum in a neonate born at full term. In addition we describe the differences between noma neonatorum and noma (cancrum oris), a clinically related entity.

Diagnosis, Differential↗
PubMed1999

Microbiological understandings and mysteries of noma (cancrum oris).

The microbiologic history of noma was reviewed. Studies have associated the disease process with large numbers of fusiform bacilli and spirochetal organisms. In order to study the microbiology of the staging and infection periods of noma 62 Nigerian children, aged 3-14 years, 22 children had acute necrotizing ulcerative gingivitis (ANUG) and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished and 20 were free of acute necrotizing ulcerative gingivitis and in good nutritional state) were evaluated for the presence of viruses and oral microorganisms. The ANUG cases in the malnourished children had a higher incidence of Herpesviridae, the main virus being detected was cytomegalovirus. There were more anaerobic microorganisms recovered, with Prevotella intermedia as the predominant isolate, in the malnourished children as compared to the healthy children. A study of the predominant microflora in active sites of noma lesions was carried out in eight noma patients, 3-15 years of age, in Sokoto State, northwestern Nigeria. Fusobacterium necrophorum was recovered from 87.5% of the noma lesions. Oral microorganisms isolated included Prevotella intermedia, alpha-hemolytic streptococci and Actinomyces spp. which were isolated from 75.0, 50.0 and 37.5% of the patients, respectively. Peptostreptococcus micros, Veillonella parvula, Staphylococcus aureus and Pseudomonas spp. were each recovered from one lesion. All strains were observed to be sensitive to all of the antibiotics tested with the exception of one strain of P. intermedia which showed resistance to penicillin. The pathogenic mechanisms of F. necrophorum as a trigger organism were discussed. The isolation from human noma lesions of F. necrophorum, a pathogen primarily associated with animal diseases, may have important etiologic and animal transmission implications.

Acute Disease↗
PubMed1999

Living conditions of children at risk for noma: Nigerian experience.

The study reported in this paper was carried out in the Northwestern and Southwestern regions of Nigeria, between October 1996 and April 1998. The study examined the possible contributory role of living conditions in the development of acute necrotizing gingivitis (ANG) or noma from oral lesions. Questionnaire data obtained from 42 fresh noma cases seen in the Northwest and four fresh cases seen in the Southwest were examined. In addition 46 cases of advanced ANG from the Southwest were included. The main focus was to compare some of the environmental living conditions of cases with advanced ANG and those with noma in these regions. All the noma and ANG cases were seen in children aged 2-12 years. The level of good oral hygiene practices and general environmental living conditions were significantly higher in the Southwest than in the Northwest. Data also showed that living in close proximity with livestock was significantly higher in the Northwest than in the Southwest (P < 0.05). The environmental living conditions of children in the Northwest were further compounded by poor sanitary faecal disposal practices as well as minimal access to potable water. The overall data indicated that living in substandard accommodations, exposure to debilitating childhood diseases, living in close proximity to livestock, poor oral hygiene, limited access to potable water and poor sanitary disposal of human and animal faecal waste could have put the children in the Northwest at higher risk for noma than the children in the Southwest. These could have been responsible for the higher prevalence of noma in the Northwest than in the Southwest.

Acute Disease↗
PubMed2002

Prevalent bacterial species and novel phylotypes in advanced noma lesions.

The purpose of this study was to determine the bacterial diversity in advanced noma lesions using culture-independent molecular methods. 16S ribosomal DNA bacterial genes from DNA isolated from advanced noma lesions of four Nigerian children were PCR amplified with universally conserved primers and spirochetal selective primers and cloned into Escherichia coli. Partial 16S rRNA sequences of approximately 500 bases from 212 cloned inserts were used initially to determine species identity or closest relatives by comparison with sequences of known species or phylotypes. Nearly complete sequences of approximately 1,500 bases were obtained for most of the potentially novel species. A total of 67 bacterial species or phylotypes were detected, 25 of which have not yet been grown in vitro. Nineteen of the species or phylotypes, including Propionibacterium acnes, Staphylococcus spp., and the opportunistic pathogens Stenotrophomonas maltophilia and Ochrobactrum anthropi were detected in more than one subject. Other known species that were detected included Achromobacter spp., Afipia spp., Brevundimonas diminuta, Capnocytophaga spp., Cardiobacterium sp., Eikenella corrodens, Fusobacterium spp., Gemella haemoylsans, and Neisseria spp. Phylotypes that were unique to noma infections included those in the genera Eubacterium, Flavobacterium, Kocuria, Microbacterium, and Porphyromonas and the related Streptococcus salivarius and genera Sphingomonas and TREPONEMA: Since advanced noma lesions are infections open to the environment, it was not surprising to detect species not commonly associated with the oral cavity, e.g., from soil. Several species previously implicated as putative pathogens of noma, such as spirochetes and Fusobacterium spp., were detected in at least one subject. However, due to the limited number of available noma subjects, it was not possible at this time to associate specific species with the disease.

Adolescent↗
PubMed2001

[Noma: Dutch history of a nearly forgotten disease].

Noma is an orofacial gangrene that may develop in malnourished and debilitated children. It was once a common disorder in the Netherlands. The medical history of noma has some important Dutch contributions. In 1595, Carel Baten was the first to describe noma as a clinical entity and in 1680, Cornelis van de Voorde coined the name 'noma' for this orofacial gangrene, thereby replacing the term 'water cancer' which was then in common usage. One of the first facial reconstruction operations on a noma patient was performed by Leendert Stelwagen in 1779. Noma gradually disappeared in the Netherlands during the second half of the nineteenth century due to an improved nutritional status amongst the poorest in society. Yet in other parts of the world approximately 110,000 children a year still die from this disorder, which has been largely forgotten in the Western world.

Child↗
PubMed1995

Noma: a neglected scourge of children in sub-Saharan Africa.

Poverty is the single most important risk indicator for noma (cancrum oris), a severe gangrene of the soft and hard tissues of the mouth, face, and neighbouring areas. The risk factors associated with an increased probability of noma developing include the following: malnutrition, poor oral hygiene, and a state of debilitation resulting from human immunodeficiency virus (HIV) infection, measles, and other childhood diseases prevalent in the tropics. There are many similarities between noma and necrobacillosis of the body surface of wallabies (Macropus reforgriseus), and it is proposed that noma results from oral contamination by a heavy load of Bacteroidaceae (particularly Fusobacterium necrophorum) and a consortium of other microorganisms. These opportunistic pathogens invade oral tissues whose defences are weakened by malnutrition, acute necrotizing gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers. The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region, which has adversely affected the health and well-being of children through deteriorating sanitation, declining nutritional status and the associated immunosuppression, and increased exposure to infectious diseases. Prevention of noma in Africa will require measures that address these problems, and most importantly, eliminate faecal contamination of foods and water supplies.

Africa South of the Sahara↗
PubMed1999

Noma: public health problem in Senegal and epidemilogical surveillance.

Noma or cancrum oris is currently a real public health problem for developing countries. In Senegal, awareness of the disease has led the country to be included in the noma programme initiated by the WHO as early as 1994. The objectives are to evaluate the incidence of necrotizing ulcerative gingivitis (NUG) among children, to evaluate the prevalence of noma and infantile diseases, and to promote prevention strategies among vulnerable populations. Data processing was carried out in two phases: manual processing consisted of checking the questionnaires by nurses, and computer processing started as early as the first collection of data. Noma occurs owing to fever and similar cases. Successfully fighting against malnutrition would allow us to reduce the noma rate.

Adolescent↗
PubMed2001

[Noma: 'the face of poverty'].

Noma (cancrum oris, water cancer) is an orofacial gangrene that may develop in malnutritioned children debilitated by concomitant diseases as measles. It has been hypothesized that the gangrene originates from acute necrotizing gingivitis, common in malnourished children in developing countries. In previous centuries noma was common in the Western world. The affection disappeared when economical progress permitted the poorest to feed their children sufficiently. The yearly incidence of noma in the world is estimated as 140,000. The mortality is +/- 90%. The facial deformities of those who survive noma are generally serious. Beside facial mutilations, oral functions are hampered (trismus, oral incontinence, impaired speech). Both prevention (improved feeding, measles vaccination) as the treatment of those who contract and survive noma are a challenge for the 'global village' of the modern world.

Africa↗
PubMed1995

[Noma or cancrum oris: etiopathogenic and nosologic aspects].

Noma is a gangrenous disease that usually begins in the mouth and is characterized by rapid necrotizing destruction of soft tissue and underlying bone. The disease, which is associated with a strong putrid odor suggestive of mixed bacterial infection, develops only in predisposed persons, especially children whose natural defenses have been weakened by poor socio-economic living conditions. However a few atypical cases have recently been reported in adults in whom the main risk factor seemed to be immunodepression. The increasing number of wars in the Third World and the AIDS epidemic raise the likelihood that the number of cases of this disease will rise sharply particularly since the incidence has been grossly underestimated for many years. It now seems clear that a combination of local and systemic risk factors are implicated in the etiopathogenesis of noma with the common denominator being a weakened immune system. This would account for the fulminating course of the infectious process due to one or more opportunistic microbial or cytopathogenic agents or even to a still undetermined immunopathologic reaction that lead to massive tissue destruction. Poor understanding of the etiopathogenesis of noma is a major factor perpetuating the nosologic problems posed by this disease. Some authors add to the confusion by including a range of gangrenous diseases under the heading of noma. It is important that the term noma be applied only to necrotizing processes that begin in the mouth and present the characteristic features and course.

Adult↗
PubMed1998

[Progressive noma: apropos of 27 cases seen at the National Hospital Center of Ouagadougou].

This retrospective study objects to report epidemiological profile, clinical display and take care of progressive noma at the National Hospital Center of Ouagadougou. We assign the term noma to the gangrenous gingivo-stomatitis occurring in a prone environment, leading in a few days into a sharp ulcer in the soft parts, accompanied by halitosis. This definition excludes noma like-lesions. 27 cases have been observed in the ENT department and the Paediatrics between 1991 and 1995. They were 17 boys and 10 girls aging between 2 and 8 years and most of them coming from families with modest income (76%). The consultation delay averaged 8 days. The research for associated pathologies showed 63% energizing and protein malnutrition. We only observed unilateral localisations and no case of extra-facial one. At the stage we received our patients, the gangrenous was formed and the aspect evoked noma right away. Quite a lot needs to be done for precocious diagnosis because it is at the beginning phase that best evolution is obtained. Even though no evidence of the responsibility of a specific pathogenic germ was established so far, nevertheless, the assumption that has more support remains that of a bacterial infection in a prone environment. The vital prognosis of the progressive noma appears to be much linked with intensive care and feeding again. The hope to see this poverty-linked pathology under control is essentially based on prevention: medical population information, medical personnel's awareness for early diagnosis and best take care of these patients, improvement of the living conditions of the people and the health care services.

Burkina Faso↗
PubMed2003

Noma: a forgotten disease.

According to recent reports from the WHO, noma (or cancrum oris), a hideous, ancient disease primarily affecting children living in poverty in parts of sub-Saharan Africa, is increasing. Noma often starts as an ulcer on the oral mucosa or as ANG and commonly after a bout of measles or other disease. It quickly develops into a massive necrosis, moving from the inside outward, often involving major portions of the face. Early treatment with antibiotics, rehydration, correction of electrolytic imbalances, and administering nutritional supplements will halt the disease. The high mortality rate, however, indicates that many children are not given care or brought for care in time. Surviving victims often display severe facial deformities that demand extensive reconstructive surgery. Current research has elucidated parts of the pathogenesis of noma. The WHO started the international Action Network Against Noma in 1992, with its official launch on the World Health Day in 1994: a five-point action plan was presented and current work follows that plan.

Africa↗
PubMed1978

Noma neonatorum: Its aetiopathogenesis.

Noma neonatorum, a gangrenous process affecting the nose, lips, mouth, anal region, and occasionally the scrotum and eyelids, affects neonates, especially low-birth-weight and premature ill babies, and is usually fatal 1-3 days after onset. In 35 cases of noma neonatorum Pseudomonas aeruginosa was isolated from blood-culture (86.3%), gangrenous areas (96.0%), rectal swabs (58.3%), and cerebrospinal fluid (60.0%). Blood-vessels in the deep cutis or subcutis were affected and the gangrenous process extended superficially. Noma in older children and adults is caused by fusospirochaetosis but noma neonatorum appears to be due to P. aeruginosa septicaemia.

Anal Canal↗
PubMed2002

Is noma neonatorum a presentation of ecthyma gangrenosum in the newborn?

Noma neonatorum was suggested as a distinct entity characterized by a gangrenous process of the nose, oral cavity, eyelids and perineum that was almost universally fatal in premature infants with Pseudomonas sepsis. We report the first case of noma neonatorum in a 26-week-gestation twin born in the United States. Our case is consistent with previous descriptions of noma neonatorum; however, we question the distinction between noma neonatorum and a neonatal presentation of ecthyma gangrenosum.

Diagnosis, Differential↗