[Noma: presentation of a case]

The noma has been rarely seen during these last decades. It is of an infections etiology, primarily affecting malnourished or immunodeficient children. It is easily confused with neoplastic tumors, tuberculosis, mycosis or gangrene ecthyma which may condition errors in treatment with severe undesirable side-effects. It has recently been associated to AIDS. A case is reported, comments are included on the diagnostic method, medical and surgical treatment and the results obtained.

Cancrum oris-like lesions

Cancrum oris is predominantly seen in children in underdeveloped countries where widespread malnutrition, dehydration and epidemic infections are present. In the western world, it is sometimes found in immunosuppressed adults with predisposing conditions such as leukaemia and infection associated with malnutrition. Early diagnosis and an intensive therapeutic approach are the key to a favourable prognosis of noma-like necro-ulcerative lesions. The prognosis is significantly improved if the predisposing condition can be removed. Two cases are presented and the treatment is discussed.

Noma and noma neonatorum

Noma and noma neonatorum are rare gangrenous diseases that result in mutilating loss of tissue in the oronasal region. Noma usually occurs in patients between the ages of 2 and 5 years who are malnourished, have suffered a precedent illness, or are in some way immunodeficient, or all of the above. The gangrenous slough is thought to be caused by a mixed infection of oral bacterial pathogens. The disease may be fatal when it occurs in a severely debilitated patient. Noma neonatorum produces somewhat similar appearing lesions in the neonate. The infectious organism is usually Pseudomonas and the disease is generally accompanied by a life-threatening pseudomonal sepsis. Both diseases are rare in North America. Patients with noma and noma neonatorum were treated at the Children's Hospital and Medical Center, Seattle, WA. We present these cases and a literature review.

Cancrum oris in an adult Caucasian female

This paper reports a case of cancrum oris in an adult Caucasian female who had no obvious pre-disposing cause. It highlights the difficulties in making this diagnosis in a part of the world unaccustomed to seeing the disease and it illustrates that early surgery and reconstruction can be undertaken. To our knowledge, this is the first published case of cancrum oris reconstructed with the use of micro-vascular free tissue transfer.

Bacterial gangrene on the cheek of a comatose patient--necrotizing fasciitis or noma

A 68-year-old Japanese woman with sepsis developed a gangrene on her left cheek from a small wound in contact with a gastric tube. Klebsiella pneumoniae was cultured from the sputum, wound, and the blood and was assumed to be responsible for this condition, possibly through thrombosis of an artery.

Hodgkin's disease presenting in the maxilla. A case report

A rare case of intra-oral, extra nodal, maxillary Hodgkin's disease (Stage I), with no other discernible tissue involvement is described and discussed. The pertinent literature is reviewed.

Noma in children with severe combined immunodeficiency

Three Native American children with severe combined immunodeficiency developed noma, a necrotizing gingivostomatitis not previously reported in this country. The similarity between the clinical findings and those observed in monkeys with simian AIDS prompted us to evaluate our patients and their families for human retroviral infection. Antibodies to HTLV-I or HTLV-III/LAV proteins were not identified in patients nor in their family members. Standard bacterial and viral cultures similarly failed to identify a suspect pathogen.

Infectious oral necrosis (cancrum oris) in Nigerian children: a review

The devastating orofacial gangrenous disease known as cancrum oris (noma) is still commonly seen in underprivileged Nigerian children. These children are usually victims of such stressors as chronic malnutrition, numerous endemic communicable diseases and severe adverse physical conditions which may lead to depletion of their adaptive resources or produce physiological maladaptation to additional stressors. Measles is the most common infection preceding the development of noma in Nigerian children. Acquired immunodeficiency as well as the impaired endocrine balance of the chronically malnourished permits, for example, widespread infection with the measles virus. Anergy resulting from the combination of malnutrition and measles virus infection promotes selective overgrowth and invasion by an infective consortium consisting of anaerobic organisms and other species capable of elaborating necessary growth factors for the former. Because of the pre-existing depletion of adaptive physiologic resources in the malnourished child, the infection is not readily contained locally as necrotizing ulcerative gingivitis but instead spreads rapidly to the next naturally occurring anatomical barriers. This is then followed by continuing necrosis and possible sequestration as exemplified by noma.

An interesting case of adult facial gangrene (from Papua, New Guinea)

A case of a nomalike lesion occurring in an elderly woman is described. The patient was admitted to the hospital in a debilitated state and was undergoing supportive management when the facial condition developed. Because of the rapidly progressing nature of the lesion, apparently emanating from the alveolar soft tissues, a diagnosis of cancrum oris was made. Although progression of the lesion was halted following institution of an appropriate therapeutic regimen, the patient's general condition deteriorated and she finally died 12 days after admission. The exact nature of the underlying systemic condition was never diagnosed.

Histopathologic changes in macaques with an acquired immunodeficiency syndrome (AIDS)

The authors recently described the clinical course of an Acquired Immunodeficiency Syndrome (AIDS) in a colony of macaque monkeys. In the present study, they have reviewed the histopathology of tissues obtained from a cohort of 16 animals with this clinical syndrome at necropsy. They found evidence in these animals of several opportunistic infections, including cytomegalovirus (CMV), simian virus 40 (SV-40), and noma. Furthermore, a number of other unusual pathologic processes were noted. In 4 animals an array of lymphoproliferative disorders was observed, ranging from multiple nodules of lymphocytes in the kidney, liver, and bone marrow, to frank lymphoma. Evidence of retroperitoneal fibrosis was found in 3 of the animals. Finally, amyloidosis was observed in several animals; in two instances it was present only in the mucosa of the small intestine.

Noma. Report of two cases

Noma is an infectious process involving the oral cavity and occasionally other structures. It is characteristically a childhood affliction, and it never occurs in healthy persons. Conservative treatment in debriding facial lesions greatly enhances reconstructive efforts.

Cancrum oris: principles of management and reconstructive surgery

A survey of 140 cases of cancrum oris in Nigerian Africans is presented. The salient clinical features, the problems of management and the modern approaches to the reconstruction of facial deformities seen in this disease are described. Mainly affected were children under the age of 10 years and the commonest involvement was the full thickness of the cheek. A high incidence of ankylosis was noted and the methods of anaesthesia and surgical correction of ankylosis are examined. The number of patients presenting for reconstruction of facial defects due to cancrum oris appears to be increasing. Preventive measures that may reduce the incidence of the disease are suggested.

Noma in a nonhuman primate

A lesion in Macaca cyclopis which appears to conform to defined characteristics of noma in human beings has been reported. Clinical features in common include the gangrenous appearance of the lesion, the association with necrotizing ulcerative gingivitis, and the massive destruction of soft tissue and bone in the oronasofacial regions. Systemic features in common include debilitation of the host, leukocytosis, and depression of cellular immunologic responses. Microbiologic studies revealed the presence of organisms commonly found in necrotizing ulcerative gingivitis. The detection of true noma in nonhuman primates may now allow the opportunity for study of the etiology, pathophysiology, and therapy of this condition for human benefit.

An oral disease resembling noma in six rhesus monkeys (Macaca mulatta)

Over a 19-month period, five rhesus monkeys developed oral lesions of gingival erosion and bone denudation with sequestration. One other rhesus monkey developed facial necrosis which communicated with the oral cavity. These lesions were consistent with those seen in the disease called noma (cancrum oris) in humans.