Noma
Gingivitis, Necrotizing Ulcerative
Fusobacterium necrophorum
Prevotella intermedia
Facial Dermatoses
Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection. (1/17)
This study showed that impoverished Nigerian children at risk for cancrum oris (noma) had significantly reduced plasma concentrations of zinc (< 10.8 micromol/L), retinol (< 1.05 micromol/L), ascorbate (< 11 micromol/L), and the essential amino acids, with prominently increased plasma and saliva levels of free cortisol, compared with their healthy counterparts. The nutrient deficiencies, in concert with previously reported widespread viral infections (measles, herpesviruses) in the children, would impair oral mucosal immunity. We postulate, subject to additional studies, that evolution of the oral mucosal ulcers including acute necrotizing gingivitis to noma is triggered by a consortium of microorganisms of which Fusobacterium necrophorum is a key component. Fusobacterium necrophorum elaborates several dermonecrotic toxic metabolites and is acquired by the impoverished children via fecal contamination resulting from shared residential facilities with animals and very poor environmental sanitation. (+info)Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981-1993. (2/17)
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. (+info)Oro-facial gangrene (noma/cancrum oris): pathogenetic mechanisms. (3/17)
Cancrum oris (Noma) is a devastating infectious disease which destroys the soft and hard tissues of the oral and para-oral structures. The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from 1 to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with Fusobacterium necrophorum (Fn) and Prevotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the two-fold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction. (+info)Prevalent bacterial species and novel phylotypes in advanced noma lesions. (4/17)
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. (+info)An estimation of the incidence of noma in north-west Nigeria. (5/17)
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. (+info)Temporal relationship between the occurrence of fresh noma and the timing of linear growth retardation in Nigerian children. (6/17)
BACKGROUND: Fresh noma (cancrum oris) occurs predominantly in children <4 years of age. The key risk factors are poverty, malnutrition and infections. Evolution from an intraoral inflammation to a grotesque oro-facial gangrene is very rapid. OBJECTIVE: We assessed potential relationship between the occurrence of fresh noma and linear growth retardation (LGR) which is prevalent in deprived Third World infants/children between ages 3 and 30 months. LGR is attributed to malnutrition and chronic immunostimulation by environmental antigens. DESIGN: Anthropometric evaluation of children (n = 91) with fresh noma, ages 0-8 years, in relation to US National Center for Health Statistics Reference values was carried out. Age-matched noma-free, poor village children (n = 151) from similar communities as noma cases, and elite urban children (n = 132) served as control groups. Heights and weights were measured and the height for age (HAZ), weight for age (WAZ) and weight for height (WHZ) scores calculated as indices of stunting, underweight and wasting respectively. Serum level of interleukin (IL)-18, a multifunctional cytokine, was also measured. RESULTS: In the age groups 0-4 and 4-8 years, the percentages of noma children <-2.0SD were 91% and 67% respectively. The corresponding values for the village children were 37% and 24% and significantly different (P < 0.001) from the noma group. Only 7% of the elite children aged 4-8 years were stunted. Low body weight and wasting were prominent features of village and noma groups, but more marked in the latter. Associated with noma was a profound increase (P < 0.001) in IL-18 in comparison with urban controls, and a 34% non-statistically significant increase relative to the village control group. Among other functions, IL-18 induces several pro-inflammatory cytokines and the matrix metalloproteinases, influences long bone growth, and consequently may be relevant to growth retardation seen in poor village children and noma victims. CONCLUSION: These results suggest that occurrence of fresh noma was probably programmed very early in life by malnutrition and chronic infections resulting from replacement of breast milk with contaminated, inferior substitutes. Although not investigated, we speculate that children with fresh noma might also be victims of intrauterine growth retardation as noma is most prevalent during the infantile phase of child growth which starts at mid-gestation and tails off at 4 years. (+info)Pseudomonas sepsis with Noma: an association? (7/17)
We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases. (+info)Noma: life cycle of a devastating sore - case report and literature review. (8/17)
Noma (cancrum oris) is an orofacial gangrene, which during its fulminating course causes progressive and mutilating destruction of the infected tissues. The disease occurs mainly in children with malnutrition, poor oral hygiene and debilitating concurrent illness. Noma is well documented in the literature, but because most patients do not report to a doctor until the disease is at an advanced stage, its onset and progression remain a mystery. This case report, with a survey of recent relevant literature, highlights the different stages in the development of tissue necrosis, including onset and progression, with an emphasis on the need for early diagnosis and prompt treatment. (+info)Noma, also known as cancrum oris, is a rare but severe gangrenous disease that primarily affects children who are malnourished, have weakened immune systems, and lack access to proper oral hygiene and healthcare. The condition typically starts as a small ulcer in the mouth and quickly progresses, causing extensive tissue damage and necrosis of the soft and hard tissues of the face.
Noma can also affect the genital region (genital noma) or the anus (anorectal noma). The disease is caused by a polymicrobial infection, involving both aerobic and anaerobic bacteria, that thrive in necrotic tissue. If left untreated, noma can result in significant disfigurement, disability, and even death.
Early diagnosis and prompt treatment with antibiotics, surgery, and nutritional support are crucial to prevent the progression of the disease and improve the chances of a successful recovery. Preventive measures, such as improving oral hygiene, promoting access to healthcare, and addressing malnutrition, can help reduce the risk of noma in vulnerable populations.
Necrotizing ulcerative gingivitis (NUG), also known as trench mouth or acute necrotizing ulcerative gingivostomatitis, is a severe and painful form of gingivitis that is characterized by the presence of necrosis (tissue death) and ulcers in the gum tissue. It is caused by a combination of factors, including poor oral hygiene, stress, smoking, and a weakened immune system. The condition is often associated with the presence of certain types of bacteria that produce toxins that can damage the gum tissue.
NUG is characterized by the sudden onset of symptoms such as severe pain, bleeding, bad breath, and a grayish-white or yellowish film covering the gums. The gums may also appear bright red, swollen, and shiny, and may bleed easily when brushed or touched. In some cases, the condition can progress to involve other areas of the mouth, such as the lining of the cheeks and lips.
NUG is typically treated with a combination of professional dental cleaning, antibiotics to eliminate the bacterial infection, and pain management. It is important to maintain good oral hygiene practices to prevent recurrence of the condition. If left untreated, NUG can lead to more serious complications such as tooth loss or spread of the infection to other parts of the body.
Fusobacterium necrophorum is a gram-negative, anaerobic, non-spore forming rod-shaped bacterium. It is a normal inhabitant of the oral cavity, gastrointestinal tract and urogenital tract of humans and animals. However, it can cause various infections in humans, particularly in individuals with compromised immune systems.
Fusobacterium necrophorum is well known for its association with severe clinical conditions such as Lemierre's syndrome, which is a rare but life-threatening condition characterized by septic thrombophlebitis of the internal jugular vein and metastatic infections. It can also cause other suppurative infections including bronchitis, pneumonia, meningitis, brain abscesses, and septicemia. In addition, Fusobacterium necrophorum has been implicated in the pathogenesis of certain types of periodontal disease and is a significant cause of bacterial peritonitis in cirrhotic patients.
Fusobacterium infections are diseases or conditions caused by the bacterial genus Fusobacterium, which are gram-negative, anaerobic bacilli. These bacteria are commonly found as normal flora in the oral cavity, gastrointestinal tract, and female genital tract. However, under certain circumstances, they can cause infections, particularly in individuals with weakened immune systems or underlying medical conditions.
Fusobacterium infections can manifest in various forms, including:
1. Oral infections: Fusobacterium nucleatum is the most common species associated with oral infections, such as periodontitis, abscesses, and Ludwig's angina.
2. Respiratory tract infections: Fusobacterium necrophorum can cause lung abscesses, empyema, and bronchitis.
3. Bloodstream infections (bacteremia): Fusobacterium species can enter the bloodstream through various routes, such as dental procedures or invasive medical procedures, leading to bacteremia. This condition can be particularly dangerous for individuals with compromised immune systems or underlying medical conditions.
4. Intra-abdominal infections: Fusobacterium species can cause intra-abdominal abscesses, peritonitis, and appendicitis.
5. Skin and soft tissue infections: Fusobacterium species can cause cellulitis, myositis, and necrotizing fasciitis.
6. Bone and joint infections: Fusobacterium species can cause osteomyelitis and septic arthritis.
7. Central nervous system infections: Fusobacterium species can cause meningitis and brain abscesses, although these are rare.
Fusobacterium infections can be challenging to treat due to their anaerobic nature and resistance to certain antibiotics. Therefore, it is essential to seek medical attention if you suspect a Fusobacterium infection. Treatment typically involves the use of appropriate antibiotics, such as metronidazole or clindamycin, and sometimes surgical intervention may be necessary.
Prevotella intermedia is a gram-negative, anaerobic, rod-shaped bacterium that is commonly found in the oral cavity, upper respiratory tract, and gastrointestinal tract. It is a normal resident of the human microbiota but can also be an opportunistic pathogen, causing various types of infections such as periodontitis, endocarditis, and brain abscesses. P. intermedia has been associated with several diseases, including respiratory tract infections, bacteremia, and joint infections. It is often found in mixed infections with other anaerobic bacteria. Proper identification of this organism is important for the selection of appropriate antimicrobial therapy.
Facial dermatoses refer to various skin conditions that affect the face. These can include a wide range of disorders, such as:
1. Acne vulgaris: A common skin condition characterized by the formation of comedones (blackheads and whiteheads) and inflammatory papules, pustules, and nodules. It primarily affects the face, neck, chest, and back.
2. Rosacea: A chronic skin condition that causes redness, flushing, and visible blood vessels on the face, along with bumps or pimples and sometimes eye irritation.
3. Seborrheic dermatitis: A common inflammatory skin disorder that causes a red, itchy, and flaky rash, often on the scalp, face, and eyebrows. It can also affect other oily areas of the body, like the sides of the nose and behind the ears.
4. Atopic dermatitis (eczema): A chronic inflammatory skin condition that causes red, itchy, and scaly patches on the skin. While it can occur anywhere on the body, it frequently affects the face, especially in infants and young children.
5. Psoriasis: An autoimmune disorder that results in thick, scaly, silvery, or red patches on the skin. It can affect any part of the body, including the face.
6. Contact dermatitis: A skin reaction caused by direct contact with an allergen or irritant, resulting in redness, itching, and inflammation. The face can be affected when allergens or irritants come into contact with the skin through cosmetics, skincare products, or other substances.
7. Lupus erythematosus: An autoimmune disorder that can cause a butterfly-shaped rash on the cheeks and nose, along with other symptoms like joint pain, fatigue, and photosensitivity.
8. Perioral dermatitis: A inflammatory skin condition that causes redness, small bumps, and dryness around the mouth, often mistaken for acne. It can also affect the skin around the nose and eyes.
9. Vitiligo: An autoimmune disorder that results in the loss of pigmentation in patches of skin, which can occur on the face and other parts of the body.
10. Tinea faciei: A fungal infection that affects the facial skin, causing red, scaly, or itchy patches. It is also known as ringworm of the face.
These are just a few examples of skin conditions that can affect the face. If you experience any unusual symptoms or changes in your skin, it's essential to consult a dermatologist for proper diagnosis and treatment.