title: Noma Neonatorum From Multidrug-Resistant Pseudomonas aeruginosa: An Underestimated Threat?
abstract: We present the case of an extremely low birth weight infant with diffuse gingival noma, initially misdiagnosed as thrush. Multidrug-resistant Pseudomonas aeruginosa strain was cultured and treated with systemic and local colistin with complete healing. Noma neonatorum from multidrug-resistant pathogens may appear in neonatal intensive care units. Old antibiotics may help.Noma (cancrum oris) is a devastating gangrenous disease that leads to destruction of facial tissue with significant morbidity and mortality in children and young adults. Noma has virtually disappeared from Europe and North America, but it is still common among children and young adults in India, Africa, and South America. Noma is a polymicrobial opportunistic infection related to malnutrition and immune dysfunction. In the neonate, a similar but distinct condition, known as "noma neonatorum" was described in 1977, in which gangrenous lesions involve the mucocutaneous junctions of oral, nasal, and anal area, and, occasionally, the eyelids and the scrotum. The neonatal disease has been linked to Pseudomonas aeruginosa, prematurity, and low birth weight. There is no established treatment, and mortality is almost inevitable in the few reported cases. In this study, we present the first European case of noma neonatorum from a multidrug-resistant strain of P aeruginosa.
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Claudio
authors.initials: C
authors.lastname: Veropalumbo
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Clara
authors.initials: C
authors.lastname: Coppola
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Sergio
authors.initials: S
authors.lastname: Maddaluno
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ferrara
authors.affiliation: Division of Maxillofacial Surgery, Università "Federico II", Naples, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cangiano
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences.
authors.forename: Letizia
authors.initials: L
authors.lastname: Capasso
mesh_terms: D003091:Colistin / Q000627:therapeutic use*; D003951:Diagnostic Errors; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005881:Gingiva / Q000382:microbiology / Q000473:pathology; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D009625:Noma / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa
chemical_list: D003091:Colistin
keywords: Pseudomonas aeruginosa; colistin; newborn; noma