Author:
- Introduction
- Medical History
- Epidemiology
- Etiological Considerations
- Pathogenesis
- Clinical Signs Preceding Noma
- Acute Noma: Stage of Edema and Halitosis
- Acute Noma: Stage of Necrosis
- Acute Noma: Stage of Sloughs and Healing
- Noma Sequelae
- Microbiology
- Preventive Measures
- Diagnosis and Treatment
- Noma: A Neglected Disease and a Violation of Human Rights
- Conclusions
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Baratti-Mayer D, Pittet B, Montandon D, Bolivar I, Bornand JE, Hugonnet S, Jaquinet A, Schrenzel J, Pittet D; Geneva Study Group on Noma, 2003. Noma: an “infectious” disease of unknown aetiology. Lancet Infect Dis 3: 419–431.
-
2.
Marck KW, 2003. A history of noma, the “face of poverty”. Plast Reconstr Surg 111: 1702–1707.
-
3.
Stewart MJ, 1912. Observations on the histopathology of cancrum oris. J Pathol 16: 221–225.
-
5.
Enwonwu CO, Falkler WA Jr, Phillips RS, 2006. Noma (cancrum oris). Lancet 368: 147–156.
-
6.
WHO, 1998. Le noma aujourd'hui. Un problème de santé publique. Rapport sur une consultation d'experts. Geneva: World Health Organization.
-
7.
Fieger A, Marck KW, Busch R, Schmidt A, 2003. An estimation of the incidence of noma in north-west Nigeria. Trop Med Int Health 8: 402–407.
-
8.
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: 1111–1114.
-
9.
Bourgeois DM, Diallo B, Frieh C, Leclercq MH, 1999. Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981–1993. Am J Trop Med Hyg 61: 909–913.
-
10.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C; Child Health Epidemiology Reference Group of WHO and UNICEF, 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 5: 1969–1987.
-
11.
Haesen S, Furst T, Utzinger J, 2013. Noma: epidemiology and global burden of a neglected disease. Joint conference of the International Society for Environmental Epidemiology (ISEE), the International Society of Exposure Science (ISES) and the International Society of Indoor Air Quality and Climate (ISIAQ). Basel, Switzerland. Abstract: 4226, ID: P-1-14-13.
-
12.
Chandra RK, 1991. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 53: 1087–1101.
-
13.
UNICEF, 2004. Low Birthweight. Country, Regional and Global Estimates. Available at: http://www.unicef.org/publications/files/low_birthweight_from_EY.pdf. Accessed July 24, 2016.
-
14.
Enwonwu CO, Phillips RS, Ferrell CD, 2005. Temporal relationship between the occurrence of fresh noma and the timing of linear growth retardation in Nigerian children. Trop Med Int Health 10: 65–73.
-
15.
Baratti-Mayer D, Gayet-Ageron A, Hugonnet S, François P, Pittet-Cuenod B, Huyghe A, Bornand JE, Gervaix A, Montandon D, Schrenzel J, Mombelli A, Pittet D; Geneva Study Group on Noma (GESNOMA), 2013. Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger. Lancet Glob Health 1: e87–e96.
-
16.
Chidzonga MM, Mahomva L, 2008. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg 66: 475–485.
-
18.
Sheiham A, 1968. The epidemiology of chronic periodontal disease in western Nigerian schoolchildren. J Periodontal Res 3: 257–267.
-
19.
Taiwo JO, 1993. Oral hygiene status and necrotizing ulcerative gingivitis in Nigerian children. J Periodontol 64: 1071–1074.
-
20.
Horning GM, 1996. Necrotizing gingivostomatitis: NUG to noma. Compend Contin Educ Dent 17: 951–954, 6, 7–8 passim; quiz 64.
-
21.
Idigbe EO, Enwonwu CO, Falkler WA, Ibrahim MM, Onwujekwe D, Afolabi BM, Savage KO, Meeks VI, 1999. Living conditions of children at risk for noma: Nigerian experience. Oral Dis 5: 156–162.
-
22.
Giddon DB, Zackin SJ, Goldhaber P, 1964. Acute necrotizing ulcerative gingivitis in college students. J Am Dent Assoc 68: 380–386.
-
23.
Goldhaber P, Giddon DB, 1963. Present concepts concerning the etiology and treatment of acute necrotizing ulcerative gingivitis. Int Dent J 14: 468–496.
-
24.
Malberger E, 1967. Acute infectious oral necrosis among young children in the Gambia, West-Africa. J Periodontal Res 2: 154–162.
-
25.
Enwonwu CO, 1972. Epidemiological and biochemical studies of necrotizing ulcerative gingivitis and noma (cancrum oris) in Nigerian children. Arch Oral Biol 17: 1357–1371.
-
26.
Sawyer DR, Nwoku AL, Rotimi VO, 1986. Comparison of oral microflora between well-nourished and malnourished Nigerian children. ASDC J Dent Child 53: 439–443.
-
27.
Holmstrup PWJ, 1997 Necrotizing Periodontal Disease. In: Lindhe J, Lange NP, Karring T, eds. Clinical Periodontology and Implant Dentistry, 3rd edition. Oxford, United Kingdom: Blackwell, 258–278.
-
28.
Pittet B, Rüegg E, Baratti-Mayer D, Jaquinet A, 2015. Le traitement chirurgical des séquelles de noma. In: EMC: Techniques chirurgicales: Chirurgie Plastique, Reconstructrice et Esthétique. Paris: Elsevier-Masson, 1–18.
-
29.
Leuzinger S, 2011. Suivi social des enfants atteints de noma ayant été transférés en Suisse en vue d'une prise en charge chirurgicale. University of Geneva thesis, Geneva, Switzerland.
-
30.
Lafferty NE, 2012. Changing the face of Africa. Liverpool School of Tropical Medicine 2012 Thesis.
-
32.
Enwonwu CO, 1998. Questions and answers on orofacial gangrene (NOMA)/Summary of notes from NOMA symposium at IADR98. Nice, France: International Association of Dental Research.
-
33.
Contreras A, Falkler WA Jr, Enwonwu CO, Idigbe EO, Savage KO, Afolabi MB, Onwujekwe D, Rams TE, Slots J, 1997. Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria. Oral Microbiol Immunol 12: 259–265.
-
34.
Falkler WA Jr, Enwonwu CO, Idigbe EO, 1999. Microbiological understandings and mysteries of noma (cancrum oris). Oral Dis 5: 150–155.
-
35.
Falkler WA Jr, Enwonwu CO, Idigbe EO, 1999. Isolation of Fusobacterium necrophorum from cancrum oris (noma). Am J Trop Med Hyg 60: 150–156.
-
36.
Bolivar I, Whiteson K, Stadelmann B, Baratti-Mayer D, Gizard Y, Mombelli A, Pittet D, Schrenzel J; Geneva Study Group on Noma (GESNOMA), 2012. Bacterial diversity in oral samples of children in niger with acute noma, acute necrotizing gingivitis, and healthy controls. PLoS Negl Trop Dis 6: e1556.
-
37.
Huyghe A, Francois P, Mombelli A, Tangomo M, Girard M, Baratti-Mayer D, Bolivar I, Pittet D, Schrenzel J; Geneva Study Group on Noma, 2013. Microarray analysis of microbiota of gingival lesions in noma patients. PLoS Negl Trop Dis 7: e2453.
-
38.
Kamma JJ, Diamanti-Kipioti A, Nakou M, Mitsis FJ, 2000. Profile of subgingival microbiota in children with primary dentition. J Periodontal Res 35: 33–41.
-
39.
Kononen E, 2000. Development of oral bacterial flora in young children. Ann Med 32: 107–112.
-
40.
Brook I, 1998. Aerobic and anaerobic microbiology of infections after trauma in children. J Accid Emerg Med 15: 162–167.
-
41.
Brook I, 1998. Microbiology of nosocomial sinusitis in mechanically ventilated children. Arch Otolaryngol Head Neck Surg 124: 35–38.
-
42.
Nath S, Jovic G, 1998. Cancrum oris: management, incidence, and implications of human immunodeficiency virus in Zambia. Plast Reconstr Surg 102: 350–357.
-
43.
Naidoo S, Chikte UM, 2000. Noma (cancrum oris): case report in a 4-year-old HIV-positive South African child. SADJ 55: 683–686.
-
44.
Rowe D, McKerrow N, Uys A, Winstanley T, 2004. Cancrum oris (noma) in a malnourished HIV-child from rural Kwazulu-Natal. South Afr J HIV Med 8: 45–46.
-
45.
Pittet B, Mahajan AL, Alizadeh N, Schlaudraff KU, Fasel J, Montandon D, 2006. The free serratus anterior flap and its cutaneous component for reconstruction of the face: a series of 27 cases. Plast Reconstr Surg 117: 1277–1288.
-
46.
Bouman MA, Marck KW, Griep JE, Marck RE, Huijing MA, Werker PM, 2010. Early outcome of noma surgery. J Plast Reconstr Aesthet Surg 63: 2052–2056.
-
47.
Bos K, Marck K, 2006. The Surgical Treatment of Noma. Alphen aan den Rijn, the Netherlands: Uitgeverij Belvédére/Medidact.
-
48.
Srour ML, Marck KW, Baratti-Mayer D, 2015. Noma: neglected, forgotten and a human right issue. Int Health 7: 149–150.
-
49.
Ziegler J, 2011. Preliminary Study on Severe Malnutrition and Childhood Diseases with Children Affected by Noma as an Example. Available at: http://righttofood.org/wp-content/uploads/2012/09/A-HRC-AC-7-CRP-2.pdf. Accessed December 28, 2016.
-
50.
Ziegler J. Noma—the Devastating Disease. Available at: http://www.righttofood.org/work-of-jean-ziegler-at-the-un/noma/. Accessed December 28, 2016.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 313 | 313 | 75 |
| Full Text Views | 1963 | 409 | 5 |
| PDF Downloads | 1311 | 309 | 6 |
Noma: Overview of a Neglected Disease and Human Rights Violation
M. Leila Srour
M. Leila Srour
Health Frontiers, Vientiane, Laos.
Search for other papers by M. Leila Srour in
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Klaas Marck
Klaas Marck
Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
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Denise Baratti-Mayer
Denise Baratti-Mayer
Geneva Study Group on Noma (GESNOMA), Service of Plastic and Reconstructive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Search for other papers by Denise Baratti-Mayer in
Current site
Google Scholar
PubMed
Search for other papers by Denise Baratti-Mayer in
Current site
Google Scholar
PubMed
Noma is an orofacial gangrene affecting malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa. Epidemiological data on noma are scarce, but a current estimate of the global incidence is 30,000–40,000 cases per year, with a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1–10 million disability-adjusted life years. The etiology of noma is multifactorial with malnutrition as an ever present factor, often in combination with concomitant diseases, such as measles, malaria, and human immunodeficiency virus (HIV), and poor oral hygiene. The pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis. Rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms. Prevention lies in food security, measles vaccination, prevention of malaria and HIV, including the early detection and treatment of necrotizing gingivitis and stomatitis. Early treatment with antibiotics may prevent gangrene or reduce its extent. Late treatment consists of surgical rehabilitation, which is often complex. However, access to medical care is very limited for noma patients due to the extremely poor conditions in which they live that are frequently located in remote rural areas. The authors support the United Nations Human Rights Council Resolution 19/7 adopted on March 22, 2012 “The right to food,” and advocate for the inclusion of noma on the list of neglected tropical diseases to encourage more medical and institutional attention for this often lethal or very mutilating infectious gangrene.
Author Notes
Authors' addresses: M. Leila Srour, Health Frontiers, Vientiane, Laos, E-mail: leila@butterflychildren.org. Klaas Marck, Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands, E-mail: k.marck@chello.nl. Denise Baratti-Mayer, Service of Plastic and Reconstructive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland, E-mail: gesnoma@bluewin.ch.
- Introduction
- Medical History
- Epidemiology
- Etiological Considerations
- Pathogenesis
- Clinical Signs Preceding Noma
- Acute Noma: Stage of Edema and Halitosis
- Acute Noma: Stage of Necrosis
- Acute Noma: Stage of Sloughs and Healing
- Noma Sequelae
- Microbiology
- Preventive Measures
- Diagnosis and Treatment
- Noma: A Neglected Disease and a Violation of Human Rights
- Conclusions
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Baratti-Mayer D, Pittet B, Montandon D, Bolivar I, Bornand JE, Hugonnet S, Jaquinet A, Schrenzel J, Pittet D; Geneva Study Group on Noma, 2003. Noma: an “infectious” disease of unknown aetiology. Lancet Infect Dis 3: 419–431.
-
2.
Marck KW, 2003. A history of noma, the “face of poverty”. Plast Reconstr Surg 111: 1702–1707.
-
3.
Stewart MJ, 1912. Observations on the histopathology of cancrum oris. J Pathol 16: 221–225.
-
5.
Enwonwu CO, Falkler WA Jr, Phillips RS, 2006. Noma (cancrum oris). Lancet 368: 147–156.
-
6.
WHO, 1998. Le noma aujourd'hui. Un problème de santé publique. Rapport sur une consultation d'experts. Geneva: World Health Organization.
-
7.
Fieger A, Marck KW, Busch R, Schmidt A, 2003. An estimation of the incidence of noma in north-west Nigeria. Trop Med Int Health 8: 402–407.
-
8.
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: 1111–1114.
-
9.
Bourgeois DM, Diallo B, Frieh C, Leclercq MH, 1999. Epidemiology of the incidence of oro-facial noma: a study of cases in Dakar, Senegal, 1981–1993. Am J Trop Med Hyg 61: 909–913.
-
10.
Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C; Child Health Epidemiology Reference Group of WHO and UNICEF, 2010. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 5: 1969–1987.
-
11.
Haesen S, Furst T, Utzinger J, 2013. Noma: epidemiology and global burden of a neglected disease. Joint conference of the International Society for Environmental Epidemiology (ISEE), the International Society of Exposure Science (ISES) and the International Society of Indoor Air Quality and Climate (ISIAQ). Basel, Switzerland. Abstract: 4226, ID: P-1-14-13.
-
12.
Chandra RK, 1991. 1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 53: 1087–1101.
-
13.
UNICEF, 2004. Low Birthweight. Country, Regional and Global Estimates. Available at: http://www.unicef.org/publications/files/low_birthweight_from_EY.pdf. Accessed July 24, 2016.
-
14.
Enwonwu CO, Phillips RS, Ferrell CD, 2005. Temporal relationship between the occurrence of fresh noma and the timing of linear growth retardation in Nigerian children. Trop Med Int Health 10: 65–73.
-
15.
Baratti-Mayer D, Gayet-Ageron A, Hugonnet S, François P, Pittet-Cuenod B, Huyghe A, Bornand JE, Gervaix A, Montandon D, Schrenzel J, Mombelli A, Pittet D; Geneva Study Group on Noma (GESNOMA), 2013. Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger. Lancet Glob Health 1: e87–e96.
-
16.
Chidzonga MM, Mahomva L, 2008. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg 66: 475–485.
-
18.
Sheiham A, 1968. The epidemiology of chronic periodontal disease in western Nigerian schoolchildren. J Periodontal Res 3: 257–267.
-
19.
Taiwo JO, 1993. Oral hygiene status and necrotizing ulcerative gingivitis in Nigerian children. J Periodontol 64: 1071–1074.
-
20.
Horning GM, 1996. Necrotizing gingivostomatitis: NUG to noma. Compend Contin Educ Dent 17: 951–954, 6, 7–8 passim; quiz 64.
-
21.
Idigbe EO, Enwonwu CO, Falkler WA, Ibrahim MM, Onwujekwe D, Afolabi BM, Savage KO, Meeks VI, 1999. Living conditions of children at risk for noma: Nigerian experience. Oral Dis 5: 156–162.
-
22.
Giddon DB, Zackin SJ, Goldhaber P, 1964. Acute necrotizing ulcerative gingivitis in college students. J Am Dent Assoc 68: 380–386.
-
23.
Goldhaber P, Giddon DB, 1963. Present concepts concerning the etiology and treatment of acute necrotizing ulcerative gingivitis. Int Dent J 14: 468–496.
-
24.
Malberger E, 1967. Acute infectious oral necrosis among young children in the Gambia, West-Africa. J Periodontal Res 2: 154–162.
-
25.
Enwonwu CO, 1972. Epidemiological and biochemical studies of necrotizing ulcerative gingivitis and noma (cancrum oris) in Nigerian children. Arch Oral Biol 17: 1357–1371.
-
26.
Sawyer DR, Nwoku AL, Rotimi VO, 1986. Comparison of oral microflora between well-nourished and malnourished Nigerian children. ASDC J Dent Child 53: 439–443.
-
27.
Holmstrup PWJ, 1997 Necrotizing Periodontal Disease. In: Lindhe J, Lange NP, Karring T, eds. Clinical Periodontology and Implant Dentistry, 3rd edition. Oxford, United Kingdom: Blackwell, 258–278.
-
28.
Pittet B, Rüegg E, Baratti-Mayer D, Jaquinet A, 2015. Le traitement chirurgical des séquelles de noma. In: EMC: Techniques chirurgicales: Chirurgie Plastique, Reconstructrice et Esthétique. Paris: Elsevier-Masson, 1–18.
-
29.
Leuzinger S, 2011. Suivi social des enfants atteints de noma ayant été transférés en Suisse en vue d'une prise en charge chirurgicale. University of Geneva thesis, Geneva, Switzerland.
-
30.
Lafferty NE, 2012. Changing the face of Africa. Liverpool School of Tropical Medicine 2012 Thesis.
-
32.
Enwonwu CO, 1998. Questions and answers on orofacial gangrene (NOMA)/Summary of notes from NOMA symposium at IADR98. Nice, France: International Association of Dental Research.
-
33.
Contreras A, Falkler WA Jr, Enwonwu CO, Idigbe EO, Savage KO, Afolabi MB, Onwujekwe D, Rams TE, Slots J, 1997. Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria. Oral Microbiol Immunol 12: 259–265.
-
34.
Falkler WA Jr, Enwonwu CO, Idigbe EO, 1999. Microbiological understandings and mysteries of noma (cancrum oris). Oral Dis 5: 150–155.
-
35.
Falkler WA Jr, Enwonwu CO, Idigbe EO, 1999. Isolation of Fusobacterium necrophorum from cancrum oris (noma). Am J Trop Med Hyg 60: 150–156.
-
36.
Bolivar I, Whiteson K, Stadelmann B, Baratti-Mayer D, Gizard Y, Mombelli A, Pittet D, Schrenzel J; Geneva Study Group on Noma (GESNOMA), 2012. Bacterial diversity in oral samples of children in niger with acute noma, acute necrotizing gingivitis, and healthy controls. PLoS Negl Trop Dis 6: e1556.
-
37.
Huyghe A, Francois P, Mombelli A, Tangomo M, Girard M, Baratti-Mayer D, Bolivar I, Pittet D, Schrenzel J; Geneva Study Group on Noma, 2013. Microarray analysis of microbiota of gingival lesions in noma patients. PLoS Negl Trop Dis 7: e2453.
-
38.
Kamma JJ, Diamanti-Kipioti A, Nakou M, Mitsis FJ, 2000. Profile of subgingival microbiota in children with primary dentition. J Periodontal Res 35: 33–41.
-
39.
Kononen E, 2000. Development of oral bacterial flora in young children. Ann Med 32: 107–112.
-
40.
Brook I, 1998. Aerobic and anaerobic microbiology of infections after trauma in children. J Accid Emerg Med 15: 162–167.
-
41.
Brook I, 1998. Microbiology of nosocomial sinusitis in mechanically ventilated children. Arch Otolaryngol Head Neck Surg 124: 35–38.
-
42.
Nath S, Jovic G, 1998. Cancrum oris: management, incidence, and implications of human immunodeficiency virus in Zambia. Plast Reconstr Surg 102: 350–357.
-
43.
Naidoo S, Chikte UM, 2000. Noma (cancrum oris): case report in a 4-year-old HIV-positive South African child. SADJ 55: 683–686.
-
44.
Rowe D, McKerrow N, Uys A, Winstanley T, 2004. Cancrum oris (noma) in a malnourished HIV-child from rural Kwazulu-Natal. South Afr J HIV Med 8: 45–46.
-
45.
Pittet B, Mahajan AL, Alizadeh N, Schlaudraff KU, Fasel J, Montandon D, 2006. The free serratus anterior flap and its cutaneous component for reconstruction of the face: a series of 27 cases. Plast Reconstr Surg 117: 1277–1288.
-
46.
Bouman MA, Marck KW, Griep JE, Marck RE, Huijing MA, Werker PM, 2010. Early outcome of noma surgery. J Plast Reconstr Aesthet Surg 63: 2052–2056.
-
47.
Bos K, Marck K, 2006. The Surgical Treatment of Noma. Alphen aan den Rijn, the Netherlands: Uitgeverij Belvédére/Medidact.
-
48.
Srour ML, Marck KW, Baratti-Mayer D, 2015. Noma: neglected, forgotten and a human right issue. Int Health 7: 149–150.
-
49.
Ziegler J, 2011. Preliminary Study on Severe Malnutrition and Childhood Diseases with Children Affected by Noma as an Example. Available at: http://righttofood.org/wp-content/uploads/2012/09/A-HRC-AC-7-CRP-2.pdf. Accessed December 28, 2016.
-
50.
Ziegler J. Noma—the Devastating Disease. Available at: http://www.righttofood.org/work-of-jean-ziegler-at-the-un/noma/. Accessed December 28, 2016.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 313 | 313 | 75 |
| Full Text Views | 1963 | 409 | 5 |
| PDF Downloads | 1311 | 309 | 6 |