Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris

The prevalence of noma in northwest Nigeria

Background

Noma, 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.

Methods

Oral 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.

Results

A 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.

Conclusions

Our 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.

Microbiological contamination of cosmetic products - observations from Europe, 2005-2018

BACKGROUND

Although cosmetic products are not expected to be fully aseptic, their potential microbiological contamination might be dangerous, especially for immunocompromised patients. The extent of such contamination of cosmetics in Europe is poorly studied.

OBJECTIVES

The objective of this study was to explore whether microbiologically contaminated cosmetic products are available for sale in Europe and what type of contamination was reported.

METHODS

We searched the European Union Rapid Information System for dangerous non-food products (Rapex), a database of non-compliant products among 31 European countries, to identify microbiologically contaminated cosmetics reported between 2005 and 2018, and present a detailed summary of these notifications.

RESULTS

In the years 2005-2018, 104 reports on microbiologically contaminated cosmetics were identified. Twenty of them were products for children. The majority of the products (65.38%) were produced in Rapex member states. In most cases, contamination was caused by Gram-negative bacteria (59.62%), mostly Pseudomonas spp. (35.58%) and Enterobacter spp. (11.54%).

CONCLUSIONS

Gram-negative rod-shaped bacteria are the most common microbiota contaminating cosmetic products in Europe. Most of the reported microbiologically contaminated cosmetics originated from European countries.