Πέμπτη, 17 Μαρτίου 2016

Noma (cancrum oris), the disease of extreme poverty and chronic malnutrition!...

From here & here.

Noma (cancrum oris) is an acute and ravaging gangrenous infection affecting the face. The victims of Noma are mainly children under the age of 6, caught in a vicious circle of extreme poverty and chronic malnutrition who suffer unimaginable pain, discomfort and social exclusion from their communities.
Noma begins with ulcers in the mouth. If the condition is detected in the early stage, progression can be prevented with the use of mild antibiotics and immediate nutritional rehabilitation.
If left 'untreated' as happens in most cases, the ulcers progress to Noma at an alarming pace.
The next step is extremely painful, when cheeks or lips begin to swell, and the victim's general condition, deteriorates.
Within a few days, the swelling increases, and a blackish furrow appears and the gangrenous process sets in, and after the scab falls away, a gaping hole is left in the face. It is estimated that the Mortality Rate reaches up to an alarming 90%
Those who survive Noma, can arguably be described as 'the fortunate ones'... However, their lives will never be the same, and they will suffer three main afflictions...
Hideous facial disfigurement; functional impairment; and social outcast.
The scar tissue restrict jaw movement, and a child who survives is unlikely ever to be able to speak or eat normally again !
In infancy, some children lose their lips, and soon die of starvation, as they are unable to breast-feed !
The World Health Organisation (WHO) estimates that 140,000 new cases of Noma occur each year, and of these, a mere 10% survive. That means that 126,000 die each year... mainly in sub-Saharan countries from Senegal to Ethiopia... a region known as 'the Noma Belt' !
The extent of the problem and its current trends are difficult to assess. The main obstacles are its presence in the poorest communities of the poorest societies with little or no access to front-line health care centres, let alone hospitals; the acceleration of Noma from its initial form to death is so rapid that few victims reach treatment facilities in time; unawareness of families and health workers who fail to identify the condition in time; and the tendency of families or communities to hide their Noma victims.
There is an immediate need for every country affected, to set up a Noma Control Plan, giving priority to early detection and immediate treatment. These countries need drugs and food supplements for patients, and help in organising the training of primary health care personnel. Mothers and pregnant women (as well as Village Leaders) need to be informed and educated. Vaccination campaigns against measles and other childhood infections which wreak havoc in poor communities, must be intensified !

From Wikipedia

Noma (also referred to as cancrum oris, fusospirochetal gangrene, necrotizing ulcerative stomatitis, stomatitis gangrenosa)[1] is a rapidly progressive, polymicrobial, often gangrenous infection of the mouth or genitals.

A man afflicted with noma
Classification and external resources
ICD-9-CM 528.1
MedlinePlus 001342
MeSH D009625


Fusobacterium necrophorum and Prevotella intermedia are thought to be key players in the process and interact with one or more other bacterial organisms (such as Borrelia vincentii, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Staphylococcus aureus, and nonhemolytic Streptococcus spp).[2]
The reported predisposing factors include:[3][4]

Noma (1836)
  • malnutrition (particularly A-and B-vitamins) or dehydration
  • poor hygiene, particularly oral
  • unsafe drinking water
  • proximity to unkempt livestock
  • recent illness
  • an immunodeficiency disease, including AIDS

The mucous membranes of the mouth develop ulcers, and rapid, painless tissue degeneration ensues, which can degrade tissues of the bones in the face.[5]
In a condition sometimes called noma pudendi, noma can also cause tissue damage to the genitals.


The disease is associated with high morbidity and mortality[6] and mainly affects children under the age of twelve in the poorest countries of Africa. Children in Asia and some countries of South America are also affected. Most children who get the disease are between the ages of two and six years old.[7] The WHO estimates that 500,000 people are affected, and that 140,000 new cases are reported each year.[8] The mortality rate is approximately 90 percent.[1]


Known in antiquity to such physicians as Hippocrates and Galen, noma was once reported around the world, including Europe and the United States. With improvements in hygiene and nutrition, noma has disappeared from industrialized countries since the 20th century, except during World War II when it was endemic to Auschwitz and Belsen concentration camps.[9] The disease and treatments were studied by Berthold Epstein, a Czech physician and forced-labor prisoner who had recommended the study under Josef Mengele's direction.[9]
The progression of the disease can be halted with the use of antibiotics and improved nutrition; however, its physical effects are permanent and may require oral and maxillofacial surgery or reconstructive plastic surgery to repair. Reconstruction is usually very challenging and should be delayed until full recovery (usually about one year following initial intervention).[10]
Children and other noma survivors in Africa are helped by a few international charitable organizations, such as Facing Africa, a UK registered charity that helps Ethiopian sufferers. There is one dedicated noma hospital in Nigeria, the Noma Children Hospital Sokoto, staffed by resident and visiting medical teams. In other countries, such as Ethiopia, international charities work in collaboration with the local health care system to provide complex reconstructive surgery which can give back facial functions such as eating, speaking and smiling. Teams of volunteer medics coming from abroad are often needed to support the local capacity to address the most severe cases, which can be extremely challenging even for senior maxillofacial surgeons.[11] On 10 June 2010 the work of such volunteer surgeons was featured in a UK BBC Two documentary presented by Ben Fogle, Make Me a New Face: Hope for Africa's Hidden Children.[12][13]

Photo from here

  • Marck, KW (2003). "A history of noma, the "Face of Poverty" (abstract)". Plast Reconstr Surg 111 (5): 1702–7. doi:10.1097/01.PRS.0000055445.84307.3C. PMID 12655218.
  • Neville, Brad. Oral and Maxillofacial Pathology (3rd ed.). Saunders Book Company. pp. 062008. 5.11.
  • Enwonwu CO (2006). "Noma--the ulcer of extreme poverty". N. Engl. J. Med. 354 (3): 221–4. doi:10.1056/NEJMp058193. PMID 16421362.
  • Enwonwu CO, Falkler WA, Phillips RS (2006). "Noma (cancrum oris)". Lancet 368 (9530): 147–56. doi:10.1016/S0140-6736(06)69004-1. PMID 16829299.
  • "AllRefer Health - Noma (Cancrum Oris, Gangrenous Stomatitis)". Retrieved 2007-07-12.
  • 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. doi:10.1046/j.1365-3156.1997.d01-220.x.
  • "The European Noma-Network". Retrieved 2007-07-12.
  • Bourgeois DM, Leclercq MH (1999). "The World Health Organization initiative on noma". Oral Dis 5: 172–174. doi:10.1111/j.1601-0825.1999.tb00085.x.
  • Lifton, Robert Jay (1986). The Nazi Doctors: Medical Killing and Psychological Genocide. Basic Books. p. 361. ISBN 0-465-04905-2.
  • Neville, Brad. Oral and Maxillofacial Pathology, 3rd Ed. Saunders Book Company, 062008. 5.11.2
  • Medical care at Project Harar
  • "Make Me a New Face: Hope for Africa's Hidden Children". BBC. June 2010. Retrieved January 13, 2016.
    1. Fogle, Ben (July 6, 2010). "Ben’s Documentary on Noma - BBC2". BenFogle.com. Retrieved January 13, 2010.
    Further reading The Surgical Treatment of noma by Kurt Boss and Klaas Marck. ISBN 978-90-71736-31-5
    External links

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