Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger

Baratti-Mayer, Denise; Gayet-Ageron, Angèle; Hugonnet, Stéphane; François, Patrice; Pittet‐Cuénod, Brigitte; Huyghe, Antoine; Bornand, Jacques-Etienne; Gervaix, Alain; Montandon, Denys; Schrenzel, Jacques; Mombelli, Andrea; Pittet, Didier

doi:10.1016/s2214-109x(13)70015-9

Cited by 70 publications

(98 citation statements)

References 34 publications

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“…More precisely, acute noma seems to be characterized by the diminution of Capnocytophaga and Fusobacteria genera and by the increase of Prevotella genus. 15,36,37 Indeed, Prevotella intermedia was already reported in previous studies undertaken with classical cultures. 35 Prevotella intermedia is a well-known periodontal pathogen in adults, but it has been detected also in the primary dentition of small children.…”

Section: Noma Sequelaementioning

confidence: 65%

“…Various diseases have been described in association with noma, such as malaria, typhus, measles, chickenpox, tuberculosis, and HIV infection. 4,15,16 Measles and malaria are the most frequently reported illnesses that precede noma. 4,5,17 These diseases often occur during the weaning period and have serious immunosuppressive effects.…”

Section: Etiological Considerationsmentioning

confidence: 99%

“…These findings invalidate the existence of a single noma pathogen and tend to reconsider noma as a multifactorial, opportunistic disease developing in a relatively normal oral flora in children suffering from chronic malnutrition. 15…”

Section: Noma Sequelaementioning

confidence: 99%

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Noma: Overview of a Neglected Disease and Human Rights Violation

Srour¹,

Marck²,

Baratti-Mayer³

2017

The American Society of Tropical Medicine and Hygiene

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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.

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Section: Noma Sequelaementioning

confidence: 65%

Section: Etiological Considerationsmentioning

confidence: 99%

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Noma: Overview of a Neglected Disease and Human Rights Violation

Srour¹,

Marck²,

Baratti-Mayer³

2017

The American Society of Tropical Medicine and Hygiene

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“…and Firmicutes (particularly Peptococcaceae and Syntrophomonadaceae ) phyla. Given that noma lesions stay localized [24], we compared bacterial content of lesion sites to non-lesion sites in an attempt to describe intra-patient differences in microbiota composition (Figure 2: column N/Nn). Noticeably, a broader bacterial diversity is found in non-lesion sites of noma samples, particularly with groups such as Proteobacteria (including Lautropia , an oral taxon of the Burkholderiaceae family), Bacteroidetes (including Capnocytophaga spp.…”

Section: Resultsmentioning

confidence: 99%

Microarray Analysis of Microbiota of Gingival Lesions in Noma Patients

Huyghe

François

Mombelli³

et al. 2013

PLoS Negl Trop Dis

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Noma (cancrum oris) is a gangrenous disease of unknown etiology affecting the maxillo-facial region of young children in extremely limited resource countries. In an attempt to better understand the microbiological events occurring during this disease, we used phylogenetic and low-density microarrays targeting the 16S rRNA gene to characterize the gingival flora of acute noma and acute necrotizing gingivitis (ANG) lesions, and compared them to healthy control subjects of the same geographical and social background. Our observations raise doubts about Fusobacterium necrophorum, a previously suspected causative agent of noma, as this species was not associated with noma lesions. Various oral pathogens were more abundant in noma lesions, notably Atopobium spp., Prevotella intermedia, Peptostreptococcus spp., Streptococcus pyogenes and Streptococcus anginosus. On the other hand, pathogens associated with periodontal diseases such as Aggregatibacter actinomycetemcomitans, Capnocytophaga spp., Porphyromonas spp. and Fusobacteriales were more abundant in healthy controls. Importantly, the overall loss of bacterial diversity observed in noma samples as well as its homology to that of ANG microbiota supports the hypothesis that ANG might be the immediate step preceding noma.

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“…This study further indicated that having a well as the main water source in comparison to other water sources such as a borehole, river or tap, was associated with having noma in the group aged 0-5 years. Well water has a high risk of contamination from nearby pit latrines or livestock, 46 and the consumption of contaminated well water is a risk factor for diarrhoea, 47 which in turn is an identified comorbidity for children with noma. 48 Vaccination coverage in all eligible children included in the study was low.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of noma in northwest Nigeria

Farley¹,

Oyemakinde

Schuurmans

et al. 2020

BMJ Glob Health

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BackgroundNoma, a rapidly progressing infection of the oral cavity, mainly affects children. The true burden is unknown. This study reports estimated noma prevalence in children in northwest Nigeria.MethodsOral screening was performed on all ≤15 year olds, with caretaker consent, in selected households during this cross-sectional survey. Noma stages were classified using WHO criteria and caretakers answered survey questions. The prevalence of noma was estimated stratified by age group (0–5 and 6–15 years). Factors associated with noma were estimated using logistic regression.ResultsA total of 177 clusters, 3499 households and 7122 children were included. In this sample, 4239 (59.8%) were 0–5 years and 3692 (52.1%) were female. Simple gingivitis was identified in 3.1% (n=181; 95% CI 2.6 to 3.8), acute necrotising gingivitis in 0.1% (n=10; CI 0.1 to 0.3) and oedema in 0.05% (n=3; CI 0.02 to 0.2). No cases of late-stage noma were detected. Multivariable analysis in the group aged 0–5 years showed having a well as the drinking water source (adjusted odds ratio (aOR) 2.1; CI 1.2 to 3.6) and being aged 3–5 years (aOR 3.9; CI 2.1 to 7.8) was associated with being a noma case. In 6–15 year olds, being male (aOR 1.5; CI 1.0 to 2.2) was associated with being a noma case and preparing pap once or more per week (aOR 0.4; CI 0.2 to 0.8) was associated with not having noma. We estimated that 129120 (CI 105294 to 1 52 947) individuals <15 years of age would have any stage of noma at the time of the survey within the two states. Most of these cases (93%; n=120 082) would be children with simple gingivitis.ConclusionsOur study identified a high prevalence of children at risk of developing advanced noma. This disease is important but neglected and therefore merits inclusion in the WHO neglected tropical diseases list.

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Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger

Abstract: Gertrude Hirzel Foundation.

Cited by 70 publications

References 34 publications

Noma: Overview of a Neglected Disease and Human Rights Violation

Noma: Overview of a Neglected Disease and Human Rights Violation

Microarray Analysis of Microbiota of Gingival Lesions in Noma Patients

The prevalence of noma in northwest Nigeria

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