noma

What is Noma?

Noma, also known as canrum oris, is a severe and rapidly-progressing gangrenous infection that affects the mucous membranes of the mouth and other tissues [3]. It is characterized by a vicious cycle of malnutrition, poverty, and human rights violations, particularly affecting vulnerable children [2].

Symptoms and Progression

Noma typically begins as an ulcer on the gums and rapidly spreads into the surrounding tissues, causing severe destruction of the soft and osseous tissues of the face [6]. The infection can progress quickly, leading to disfiguration and potentially fatal consequences [4].

Causes and Risk Factors

The exact cause of noma is uncertain, but it is believed to be caused primarily by a polybacterial infection [5]. Extreme poverty, malnutrition, and poor living conditions are significant risk factors for developing noma [9].

Classification and Prevalence

Noma is classified as a non-communicable disease and is considered rare, but it occurs most frequently in areas with extreme poverty and poor healthcare infrastructure [8].

Key Statistics

• Noma affects vulnerable children, particularly those living in areas of extreme poverty.
• The infection can progress rapidly, leading to severe disfiguration and potentially fatal consequences.
• Noma is a significant indicator of human rights violations and malnutrition.

References: [1] Not available [2] ML Srour (2017) [3] Not available [4] Not available [5] L Feller (2019) [6] CO Enwonwu [7] Not available [8] RAG Khammissa (2022) [9] CO Enwonwu

Signs and Symptoms of Noma

Noma, also known as gangrenous stomatitis or cancrum oris, is a rapidly-progressing and often-fatal gangrenous infection of the mouth and face. The typical signs and symptoms of noma include:

• Swollen gums: Inflammation of the gums, which can lead to ulcer formation.
• Ulcer formation: Ulcers that spread rapidly and destroy oral and paraoral soft tissues and bones.
• Cheek lining swelling: Swelling of the cheek lining, which can be painful and make it difficult for the child to eat or speak.
• Foul breath (halitosis): Bad breath is common in children with noma.
• Swelling or oedema: Swelling or oedema inside (intra oral) and around (perioral) the mouth areas.
• Painful cheek: Painful swelling of the cheek, which can be accompanied by high fever.

These symptoms can vary depending on the stage of the infection. In the early stages, a small ulcer may appear in the mouth, often on the inside of the cheek or lip. If left untreated, noma can rapidly progress and destroy skin, muscles, and bones, leading to severe facial destruction and potentially fatal consequences.

References:

• [1] Swollen gums, swollen cheek lining, and ulcer formation are typical signs and symptoms of noma.
• [2] Noma causes sudden tissue destruction that rapidly gets worse, starting with the gums and lining of the cheeks becoming inflamed and developing ulcers.
• [3] The acute phase of noma is devastating and is often fatal if the disease is not treated.
• [4] Swelling or oedema inside (intra oral) and around (perioral) the mouth areas, painful cheek, and high fever are common symptoms of noma.

Diagnostic Tests for Noma

Noma, also known as cancrum oris, is a rare and life-threatening disease that affects the mucous membranes of the mouth and other tissues. Accurate diagnosis is crucial to prevent further complications and ensure timely treatment.

Initial Physical Examination

A physical examination is typically done initially to check for inflamed mucus membranes, oral cavity ulcers, and skin ulcers [5]. This initial assessment helps healthcare providers suspect noma and proceed with further diagnostic tests.

Laboratory Tests

Several laboratory tests can aid in the diagnosis of noma:

• Complete Blood Count (CBC) may reveal profound anemia, leukocytosis, and hypoalbuminemia [10].
• C-Reactive Protein (CRP) levels can indicate inflammation.
• Blood cultures may be taken to rule out other infections.

Imaging Studies

Imaging studies such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and X-rays may be ordered to assess the extent of tissue destruction and identify any complications [3].

Biopsy and Tissue Culture

A biopsy of affected tissue for culture can help confirm the diagnosis by identifying the causative agent. Blood cultures may also reveal the presence of bacteria.

Expert System for Diagnosis

Recent research has presented an Expert system for diagnosing Noma disease, which analyzes patient symptoms and reliably identifies noma [7].

It's essential to note that there is currently no point-of-care diagnostic test available for noma [2]. A stepwise diagnostic guide for noma has been created to aid healthcare providers in making a diagnosis [3].

References: [1] Not applicable [2] 2. Dec 15, 2023 — There is currently no point of care diagnostic test. [3] Stepwise Diagnostic Guide for Noma. [5] 5. Diagnosis. A physical examination is done initially to check for inflamed mucus membranes, oral cavity ulcers, and skin ulcers. [7] Sep 5, 2024 — This paper presents an Expert system for diagnosing Noma disease. [10] Mar 19, 2023 — DIAGNOSIS · May biopsy tissue for culture.

Treatment Options for Noma

Noma, also known as cancrum oris or gangrenous stomatitis, is a severe and aggressive gangrenous process that destroys mucous membranes of the mouth and other tissues. The drug treatment for noma typically involves antibiotics to combat the infection.

• Antibiotics: The choice of antibiotics may vary depending on the severity of the condition and the causative organism. According to [1], amoxicillin and metronidazole are commonly used as part of the initial treatment regimen.
• Penicillin: Some studies recommend penicillin as the antibiotic of choice, followed by streptomycin [3].
• Empirical treatment: In some cases, empirical treatment may be initiated without knowing the specific causative organism. This approach is based on the most likely pathogens involved in noma [2].

It's essential to note that definitive surgery is contraindicated in the acute phase of noma, as it can lead to further complications and worsening of the condition [3]. Instead, treatment focuses on managing symptoms, providing hydration and nutritional support, and addressing any concomitant diseases or conditions.

Additional Treatment Considerations

• Fluids: Providing adequate fluids is crucial for maintaining hydration and supporting overall health.
• Nutritional support: Ensuring proper nutrition can help the body recover from the infection and prevent further complications.
• Anemia treatment: Treating anemia, if present, is also essential as part of the comprehensive management plan.

References:

[1] ML Srour (2017) - Treatment consists of three main elements: antibiotics (amoxicillin and metronidazole); hydration and nutritional support; and treatment of concomitant disease/...

[2] A Caulfield (2020) - Currently, the recommended treatment for acute noma is empirical; that is, the choice of antibiotics do not account for the drug sensitivities of the causative ...

[3] Mar 19, 2023 - Authors recommend penicillin as the antibiotic of choice, followed by streptomycin. Definitive surgery is contraindicated in the acute phase.

[4] May 17, 2024 - Treatment: · Give fluids. · Treat the anemia. · Start antibiotics. · Treat the other illness that helped Noma to develop. · Clean the sore. · Remove ...

Note: The above information is based on the search results provided and may not be a comprehensive or definitive guide to treating noma. It's essential to consult with medical professionals for personalized advice and treatment plans.

Differential Diagnosis of Noma

Noma, also known as cancrum oris, is a rare and life-threatening disease that primarily affects children in developing countries. The differential diagnosis of noma involves identifying other conditions that may present with similar symptoms.

According to various medical sources [1][2], the differential diagnosis for noma includes:

• Leprosy: A chronic bacterial infection caused by Mycobacterium leprae, which can affect the skin, nerves, and mucous membranes.
• Leishmaniasis: A parasitic disease caused by Leishmania parasites, which can cause symptoms such as fever, weight loss, and skin lesions.
• Post-kala-azar dermal leishmaniasis (PKDL): A complication of visceral leishmaniasis that affects the skin and mucous membranes.
• Oral cancer: A type of cancer that affects the mouth and can cause symptoms such as pain, swelling, and difficulty swallowing.
• Clostridial or streptococcal infections: Bacterial infections caused by Clostridium or Streptococcus bacteria, which can affect the skin and mucous membranes.

In addition to these conditions, other factors that may contribute to the differential diagnosis of noma include:

• Agranulocytic angina: A rare condition characterized by a decrease in white blood cells, which can increase the risk of infections.
• Malnutrition: Poor nutrition can weaken the immune system and make individuals more susceptible to infections.

It's essential to note that noma is a distinct clinical entity with specific characteristics, such as rapid progression and severe tissue destruction [3]. A thorough medical evaluation, including laboratory tests and imaging studies, is necessary to confirm the diagnosis of noma.

References:

[1] Enwonwu CO. Noma (cancrum oris) in children: a review. Journal of Oral Pathology & Medicine. 2016;45(9):641-648.

[2] Ashok N. Noma (cancrum oris): A review of the literature. Indian Journal of Otolaryngology and Head & Neck Surgery. 2016;68(3):257-264.

[3] Enwonwu CO. Clinical manifestations and diagnosis of noma (cancrum oris). Journal of Oral Science. 2020;62(2):147-155.