A Review on Noma: A Recent Update

Abstract

Noma is a gangrenous infection primarily affecting under developed countries. The aim of this paper was to review all recent articles on noma from January 2003 to August 2014 and briefly update the latest information related to the topic. A literature search was done on PUBMED using the keywords “noma / cancrum oris”. Noma is commonly seen in malnourished children. There has been an increased incidence of noma in HIV patients. Apart from these, noma has also been reported in association with cyclic neutropenia, herpetic stomatitis, leukemia, Down's syndrome and Burkett's disease. Treatment of acute noma includes transfusion of blood and intravenous fluids, administration of antibiotics, putting the patient on a high protein diet and debridement of necrotic areas. Surgical phase is usually initiated 6 to 18 months after a period of quiescence. Although, the mortality rate associated with noma has reduced significantly with the advent of modern generation antibiotics, the functional, cosmetic and psychological challenges associated with the destruction of soft or hard tissues still remains a huge challenge. Adequate steps must be implemented by the government or medical professionals to prevent the disease and provide an early intervention.

The Real Face of “Face of Poverty”: An Insight on Noma

“…Severe cosmetic disfigurement can also take place from the resulting scarring and loss of tissue. 13 Cases have been reported of a high psychiatric morbidity after noma. The resultant facial asymmetry increases with the growth of the child.…”

“…20,21 The affected area should be debrided with dilute hydrogen peroxide or Edinburgh university solution of lime (EUSOL) or saline and any remaining tissue slough and sequestrate and any mobile tooth must be removed. 13,21 Other diseases such as malaria, tuberculosis, parasites, and skin disorders should be addressed and treated. The patient must be screened for HIV infection and referred appropriately.…”

Epidemiological Investigation of Noma in Papua Province in 2017

“…Noma occurs mainly in poor communities who are untouched by health services and have a nomadic lifestyle. Noma cases are mostly reported in Africa and in the dry season when food is scarce and when the incidence of measles is high (Ashok et al, 2016). The Korowai are a tribe that lives in the inland of Papua.…”

“…Ironically, the peak incident occurs in toddlers aged 1-4 years. Children who received medical treatment of these acute cases were found only about 15%, while others were sent to live in exile rather than being taken to medical care, because noma was considered an embarrassing disease, thus often resulting in forced isolation from the community and family (Ashok, Tarakji, Darwish, Rodrigues, & Altamimi, 2016;Braimah, et al, 2017). Noma generally occurs in populations with extreme levels of poverty, severe malnutrition, unsafe drinking water, poor sanitation, poor oral hygiene, high infant mortality, limited access to health services, and intrauterine growth retardation .…”

“…This is because mothers leave their babies after giving birth and cared for by their grandmothers. Grandmothers who lack knowledge about balanced food, cause malnutrition in infants which can have an impact on the emergence of noma disease (Ashok et al, 2016).…”