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Am. J. Trop. Med. Hyg., 60(2), 1999, pp. 223-232
Copyright © 1999 by The American Society of Tropical Medicine and Hygiene

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American Journal of Tropical Medicine and Hygiene, Vol 60, Issue 2, 223-232
Copyright © 1999 by American Society of Tropical Medicine and Hygiene

Research Articles


Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection

CO Enwonwu, Falkler WA Jr, EO Idigbe, BM Afolabi, M Ibrahim, D Onwujekwe, O Savage, and VI Meeks

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.


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