is a gangrenous infection that causes rapid, widespread orofacial destruction
most frequently affects children between 2 and 5 years of age who live in low-income settings in Africa and Asia (2)
the World Health Organization (WHO) estimates that 140,000 new cases of noma occur annually (2)
affects malnourished children and mainly observed in tropical countries, particularly sub-Saharan Africa (3)
was once frequently reported in Europe and North America, although as living conditions improved in these settings, noma has been eradicated (besides a few sporadic cases in immunocompromised individuals)
leukaemic patients:
often a terminal complicaton of the disease
associated with the use of anti-inflammatory and immunosuppressive drugs
a mortality rate of approximately 85% and a burden of disease calculated to be a loss of 1-10 million disability-adjusted life year (3)
cause of noma is unknown, and noma is not contagious (1)
main risk factors for noma include chronic malnutrition, a lack of access to healthcare (specifically immunizations), and comorbidities such as measles and human immunodeficiency virus (HIV)
measles:
especially in the malnourished, typically in children in tropical Africa
cranium oris develops from an acute, ulcerative gingivitis
pathogenesis is a fast-spreading, noncontagious gangrenous infection occurring in the face, often preceded by acute necrotizing gingivitis, and stomatitis (3)
rare microbiological studies suggest an opportunistic infection caused by an imbalance in normal intraoral microorganisms
WHO classifies noma into stages: Stage 0: simple gingivitis, Stage 1: acute necrotizing gingivitis, Stage 2: oedema, Stage 3: gangrene, Stage 4: scarring, and Stage 5: sequelae
reported mortality rate for untreated patients is 90% within weeks after the onset of first symptoms (1)
treatment in the early acute stages with antibiotics, wound debridement, and nutritional support greatly reduces mortality and morbidity
late treatment consists of surgical rehabilitation, which is often complex (3)
survivors of the acute stages of noma face a lifetime of functional challenges such as difficulty eating and speaking
Reference:
Farley E, Ariti C, Amirtharajah M, et al. Noma, a neglected disease: A viewpoint article. PLoS Negl Trop Dis. 2021;15(6):e0009437. Published 2021 Jun 17. doi:10.1371/journal.pntd.0009437
Srour ML, Marck K, Baratti-Mayer D. Noma: Overview of a Neglected Disease and Human Rights Violation. Am J Trop Med Hyg. 2017;96(2):268-274. doi:10.4269/ajtmh.16-0718
Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.