Noma: Report of Three Adult Cases*

Bendl, Bernard J.; Padmos, Andrew; Harder, Edward J.; McArthur, Peter

doi:10.1111/j.1440-0960.1983.tb00267.x

Cited by 12 publications

(8 citation statements)

References 20 publications

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“…3,4 Although noma is observed in adults, 9 the disease typically affects mostly children between three and 12 years of age. 1,10,11 Poverty is the most important cause of noma in Africa, 3 and chronic malnutrition is a major predisposing factor.…”

mentioning

confidence: 99%

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

Enwonwu¹,

Falkler²,

Idigbe³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

107

129

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Abstract. This study showed that impoverished Nigerian children at risk for cancrum oris (noma) had significantly reduced plasma concentrations of zinc (Ͻ 10.8 mol/L), retinol (Ͻ 1.05 mol/L), ascorbate (Ͻ 11 mol/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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mentioning

confidence: 99%

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

Enwonwu¹,

Falkler²,

Idigbe³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

107

129

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“…We documented Enterococcus spp as the possible offending agent, and this organism is reported to be associated with Noma 8 10…”

Section: Global Health Problem Analysismentioning

confidence: 85%

Noma in a child with acute leukaemia: when the ‘face of poverty’ finds an ally

et al. 2016

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A 2-year-6-month old, appropriately immunised, well-thriving boy, symptomatic for the past 6 months, presented with recurrent fever, progressive pallor, lymphadenopathy and a raw area on the right cheek, with discharging sinus. The necrotising infection of the face developed after one and half months of febrile illness. This febrile illness with bicytopaenia was diagnosed as enteric fever and treated with antibiotics. Skin grafting was performed for the full-thickness defect of the face. The patient continued to have a non-healing oral ulcer with progressive pallor and was finally diagnosed as having acute lymphoblastic leukaemia. Immunodeficiency was ruled out by appropriate investigations. Noma is an indirect measure of extreme poverty, but malignancy is known to predispose to this debilitating condition. The worldwide incidence of Noma is reported to be 30 000–140 000, with a preponderance in sub-Saharan Africa. This case emphasises the need for a thorough search for the underlying illness predisposing to a rare opportunistic infection such as Noma in a well-thriving child.

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“…Les prélèvements effectués chez notre patiente ont révélé la présence de Pseudomonas aeruginosa. Ce bacille gram-négatif a été fréquemment retrouvé dans des cas similaires de stomatites nécrosantes [18,28,29] mais aussi dans le noma [7,30], et plus généralement dans des foyers d'ostéites [31]. Un cas de nécrose muqueuse et osseuse, localisé au maxillaire, présentant une surinfection fongique par Trichoderman longibrachiatum a été rapporté chez une femme de 66 ans atteinte d'un lymphome qui présentait une neutropénie sévère.…”

Section: After 19 Months Mandibular and Maxilla Mucosa Has Healed unclassified

Un cas de stomatite nécrosante : noma des pays riches ?

Catros

Prudence²,

Lerici³

et al. 2014

Med Buccale Chir Buccale

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Introduction : Il existe très peu de cas publiés de stomatites nécrosantes massives chez des patients immunodéprimés et aucun dans le cadre d'un traitement par méthotrexate (MTX). Le cas rapporté décrit une stomatite nécrosante sévère avec exfoliations dentaires spontanées chez une patiente immunodéprimée. Observation : Une femme de 45 ans, traitée par MTX et infliximab, a développé des ulcérations buccales, suggérant une toxicité du MTX. Malgré l'arrêt du MTX, les ulcérations se sont étendues, entrainant une nécrose osseuse avec exfoliation spontanée de plusieurs dents maxillaires. Une antibiothérapie probabiliste et une nutrition parentérale ont été instaurées, ce qui a permis une amélioration rapide de l'état général. Un mois plus tard, l'exposition osseuse concernait le tiers antérieur du palais et une partie de la mandibule. Les séquestres osseux ont été progressivement réséqués pour obtenir une fermeture muqueuse complète après 19 mois. Les prélèvements bactériens ont montré la présence de Pseudomonas aeruginosa et l'examen histopathologique des séquestres osseux a confirmé le processus de nécrose. Discussion : Le contexte de dénutrition et l'évolution favorable après mise en place de la nutrition parentérale et de l'antibiothérapie évoquent une forme de noma où il n'y aurait pas eu d'évolution vers les tissus mous musculo-cutanés du voisinage. Abstract -A case of necrotizing stomatitis: noma of the rich countries? Introduction:There are few cases of massive necrotizing stomatitis in immuno-compromised patients described in the literature and methotrexate has not been observed to induce such clinical manifestations. We report the case of a severe necrotizing stomatitis, including spontaneous dental exfoliations in an immuno-compromised patient. Case report: A 45-year-old female patient, treated by methotrexate (MTX) and infliximab, has developed oral mucosa ulcerations, suggesting a toxicity of MTX. Even if MTX was stopped, ulcerations have increased, leading to underlying bone necrosis along with spontaneous exfoliation of several maxillary teeth. Broad-spectrum antibiotherapy and parenteral nutrition have been established, which lead to a quick amelioration of general condition. One month later, bone exposure concerned the anterior part of palate and mandible. Bone sequestrums have been progressively removed and a complete mucosal closure was observed after 19 months. Bacterial swabs have revealed the presence of Pseudomonas aeruginosa and histopathological examination showed evidence of bone necrosis. Discussion: The medical history of denutrition and the clinical aspect of the lesions are close to the classical description of noma even if no extent towards soft tissues was observed.

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Noma: Report of Three Adult Cases*

Cited by 12 publications

References 20 publications

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

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

Noma in a child with acute leukaemia: when the ‘face of poverty’ finds an ally

Un cas de stomatite nécrosante : noma des pays riches ?

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