Noma

Noma (Cancrum oris) is a polymicrobial infection often preceded by acute necrotizing gingivitis. Gingival ulcers advance rapidly into orofacial tissues, develops blackened necrotic center, and then perforates the cheek with a deep wound exposing bones and teeth.

CASES/YEAR
5 (US); 120,000 (Global)
CATEGORY
Localized Infections
AGENT TYPE
Bacteria
OTHER NAMES
Cancrum oris
ACUITY
Subacute/Chronic
INCUBATION
Unknown;
INITIAL SYMPTOMS
Often preceded by acute necrotizing gingivitis; Gingival ulcer advances rapidly into orofacial tissues, develops blackened necrotic center, and then perforates the cheek with a deep wound exposing bones and teeth; [CCDM]
PRECAUTIONS
Not transmitted from person to person; [CCDM]
COMMENTS
The three stages of this polymicrobial infection are acute, gangrenous, and scarring. Affected children (peaks at 1-4 years of age) have fever and submandibular lymphadenopathy. Complications of scarring include trismus and facial disfigurement. Risk factors include poverty, living with livestock, intergenerational malnutrition, and high prevalence of HIV/AIDS and other diseases. [CCDM, p. 432-4] "The earliest lesion is a small, painful red spot or vesicle on the attached gingiva in the premolar or molar region of the mandible." [PPID, p. 870]
DIAGNOSTIC
Clinical;
SCOPE
Rare in industrialized countries; "Noma belt" includes Niger, Nigeria, Senegal, Burkina Faso, and Ethiopia; Cases have been reported in Lao People's Democratic Republic and Haiti; [CCDM]
SIGNS & SYMPTOMS
  • >fever
  • E dysphagia
  • E stomatitis
  • H lymphadenopathy
  • S ulcer of skin
  • *osteomyelitis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
RESERVOIR
Cattle, Goats and Sheep, Monkeys, Wild Animals
RISK FACTORS
  • AIDS patients
TREATMENT
Treated with penicillin + metronidazole, amoxicillin + metronidazole, or metronidazole only; [CCDM] Treatment requires high-dose IV antibiotics; [PPID, p. 870]
DRUG LINK
REFERENCES FOR CASES/YEAR
1.
2. WHO estimates 100,000 to 140,000 new cases each year; [CCDM, p. 434]