title: Noma: an "infectious" disease of unknown aetiology.
abstract: Noma (cancrum oris) is a devastating gangrenous disease that leads to severe tissue destruction in the face and is associated with high morbidity and mortality. It is seen almost exclusively in young children living in remote areas of less developed countries, particularly in Africa. The exact prevalence of the disease is unknown, but a conservative estimate is that 770000 people are currently affected by noma sequelae. The cause remains unknown, but a combination of several elements of a plausible aetiology has been identified: malnutrition, a compromised immune system, poor oral hygiene and a lesion of the gingival mucosal barrier, and an unidentified bacterial factor acting as a trigger for the disease. This review discusses the epidemiology, clinical features, current understanding of the pathophysiology, and treatment of the acute phase and sequelae requiring reconstructive surgery. Noma may be preventable if recognised at an early stage. Further research is needed to identify more exactly the causative agents.
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Denise
authors.initials: D
authors.lastname: Baratti-Mayer
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pittet
authors.forename: Denys
authors.initials: D
authors.lastname: Montandon
authors.forename: Ignacio
authors.initials: I
authors.lastname: Bolivar
authors.forename: Jacques-Etienne
authors.initials: JE
authors.lastname: Bornand
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hugonnet
authors.forename: Alexandre
authors.initials: A
authors.lastname: Jaquinet
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000349:Africa / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D006801:Humans; D007223:Infant; D009625:Noma / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors