title: Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger.
abstract: BACKGROUND
  Noma is a poorly studied disease that leads to severe facial tissue destruction in children in developing countries, but the cause remains unknown. We aimed to identify the epidemiological and microbiological risk factors associated with noma disease.
  
  
  METHODS
  We did a prospective, matched, case-control study in Niger between Aug 1, 2001, and Oct 31, 2006, in children younger than 12 years to assess risk factors for acute noma. All acute noma cases were included and four controls for each case were matched by age and home village. Epidemiological and clinical data were obtained at study inclusion. We undertook matched-paired analyses with conditional logistic regression models.
  
  
  RESULTS
  We included 82 cases and 327 controls. Independent risk factors associated with noma were: severe stunting (odds ratio [OR] 4·87, 95% CI 2·35-10·09) or wasting (2·45, 1·25-4·83); a high number of previous pregnancies in the mother (1·16, 1·04-1·31); the presence of respiratory disease, diarrhoea, or fever in the past 3 months (2·70, 1·35-5·40); and the absence of chickens at home (1·90, 0·93-3·88). After inclusion of microbiological data, a reduced proportion of Fusobacterium (4·63, 1·61-13·35), Capnocytophaga (3·69, 1·48-9·17), Neisseria (3·24, 1·10-9·55), and Spirochaeta in the mouth (7·77, 2·12-28·42), and an increased proportion of Prevotella (2·53, 1·07-5·98), were associated with noma. We identified no specific single bacterial or viral pathogen in cases.
  
  
  CONCLUSIONS
  Noma is associated with indicators of severe poverty and altered oral microbiota. The predominance of specific bacterial commensals is indicative of a modification of the oral microbiota associated with reduced bacterial diversity.
  
  
  BACKGROUND
  Gertrude Hirzel Foundation.
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Denise
authors.initials: D
authors.lastname: Baratti-Mayer
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Clinical Epidemiology, Department of Community Health and Medicine, University of Geneva Hospitals, Geneva, Switzerland; Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Hugonnet
authors.affiliation: Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Patrice
authors.initials: P
authors.lastname: François
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pittet-Cuenod
authors.affiliation: Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva, Sciences III, Department of Plant Biology, Microbiology Unit, Geneva, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Huyghe
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Central Laboratory of Virology, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Jacques-Etienne
authors.initials: JE
authors.lastname: Bornand
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Department of Paediatrics, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Alain
authors.initials: A
authors.lastname: Gervaix
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Denys
authors.initials: D
authors.lastname: Montandon
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Department of Periodontology and Oral Pathophysiology, School of Dental Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mombelli
authors.affiliation: GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland. Electronic address: didier.pittet@hcuge.ch.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D001722:Birth Order; D002206:Capnocytophaga / Q000235:genetics / Q000302:isolation & purification; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D005334:Fever / Q000453:epidemiology; D005673:Fusobacterium / Q000235:genetics / Q000302:isolation & purification; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D064307:Microbiota / Q000235:genetics*; D009055:Mouth / Q000382:microbiology*; D009343:Neisseria / Q000235:genetics / Q000302:isolation & purification; D009548:Niger / Q000453:epidemiology; D009625:Noma / Q000097:blood / Q000453:epidemiology* / Q000382:microbiology; D011203:Poverty / Q000706:statistics & numerical data*; D018720:Prevotella / Q000235:genetics / Q000302:isolation & purification; D011446:Prospective Studies; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D012307:Risk Factors; D013142:Spirochaeta / Q000235:genetics / Q000302:isolation & purification; D014801:Vitamin A / Q000097:blood; D019282:Wasting Syndrome / Q000453:epidemiology; D024502:alpha-Tocopherol / Q000097:blood
chemical_list: D012336:RNA, Ribosomal, 16S; D014801:Vitamin A; D024502:alpha-Tocopherol