title: Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe.
abstract: OBJECTIVE
  This retrospective study describes the clinical features and management of noma (cancrum oris) in patients with HIV and AIDS.
  
  
  METHODS
  Records of 48 consecutive patients with noma (cancrum oris) seen between July 2002 and November 2006 were reviewed for age, gender, clinical features, and management. Other reports on noma in HIV and AIDS in Zimbabwe were also reviewed.
  
  
  RESULTS
  There were 48 patients included; 35.4% (n = 17) were males, of which 64.7% (n = 11) were children (16 years and younger) and 35.3% (n = 6) were adults; 64.6% (n = 31) were females, out of which 87.1% (n = 27) were children and 12.9% (n = 4) were adults. The average age was 14.2 years (range, 3 to 30 years) for males and 9.2 years (range, 1 to 36 years) for females. The average age for the entire group was 11 years (range, 1 to 36 years). All patients were HIV-positive by the ELISA method. Only 13 patients had CD4 cell and CD8 cell count obtained, ranging from 10 to 594 cells/microL with a CD4/CD8 ratio ranging from 0.02 to 0.45. Only 5 patients had microbiologic investigations conducted, isolating Staphylococcus aureus, Klebsiella species, group D Streptococcus, and group B hemolytic Streptococcus. Isolated cheek defect (37.5%) was most common, followed by the type I and type IV defect (25% each). Administration of antibiotics, nutritional support, wound debridement, and sequestrectomy were conducted before definitive reconstructive surgery. Facial reconstruction was performed using distant and local advancement flaps. No bony reconstruction was performed. Satisfactory results were achieved with minimal infection and flap breakdown. Follow-up was difficult; patients were lost to follow-up within 6 to 12 months after surgery.
  
  
  CONCLUSIONS
  Noma cases are on the increase in line with the current HIV and AIDS epidemic. Female children appear to be more commonly affected than their male counterparts. Reconstructive surgery is possible in patients with low CD4/CD8 ratios because of HIV infection.
authors.affiliation: Department of Dentistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe. mmchidzonga@medsch.uz.ac.zw
authors.forename: Midion Mapfumo
authors.initials: MM
authors.lastname: Chidzonga
authors.forename: Leonard
authors.initials: L
authors.lastname: Mahomva
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000293:Adolescent; D000328:Adult; D015704:CD4 Antigens / Q000032:analysis; D018791:CD4 Lymphocyte Count; D016516:CD4-CD8 Ratio; D016827:CD8 Antigens / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D008297:Male; D009625:Noma / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D044623:Nutrition Therapy; D019647:Oral Surgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D015030:Zimbabwe
chemical_list: D015704:CD4 Antigens; D016827:CD8 Antigens