1/8. Noma (cancrum oris): case report in a 4-year-old hiv-positive South African child.Cancrum oris (noma) is a gangrenous infection that develops in the mouth and spreads rapidly to other parts of the face. The disease occurs mostly in conditions of poverty, poor hygiene and malnutrition. In sub-Saharan africa the frequency in several countries is estimated to be 1-7 cases per 1,000 population, and as many as 12 cases per 1,000 in the most affected communities. About 90% of these children die without receiving any care, yet the disease can, and should, be prevented. With increasing numbers of children who are malnourished and who have compromised immune systems (compounded by the hiv pandemic) the prevalence of conditions such as noma is likely to increase. Among the earliest features of noma are excessive salivation, marked fetor oris, facial oedema and a greyish-black discolouration of the skin in the affected area. This devastating gangrenous lesion may involve the cheek, the chin, the infra-orbital margin, palate, nose, antrum and virtually any part of the face. This report describes a 4-year-old hiv-positive African girl, who was abandoned, discharged from the plastics Unit and now lives in a child care sanctuary. Little is known about her history prior to her arrival at the home a few weeks previously. The clinical examination revealed a delay in growth and physical development equivalent to that of a 2-year-old child. The left cheek had a perforating ulcer in a healing phase. The perforation, about 1 cm in diameter, was surrounded by oedematous tissues showing a mild to moderate erythema. The peripheral oedema extended to the lower palpebral, the upper labial, left labial commissural, mandibular and pre-parotid regions. Submental, submandibular and cervical lymph nodes were mildly painful upon palpation. The child was not pyretic. The intra-oral examination revealed the features of acute necrotising gingivitis (ANG). ANG was generalised and showed classic interdental crater-like ulcers covered with whitish debris. halitosis was pronounced. Examination of the second quadrant revealed a large ulcer extending from the distal aspect of the deciduous canine to the distal aspect of the second deciduous molar. The adjacent palatal mucosa was severely oedematous. The alveolar bone supporting the first and the second molars was completely exposed to the fundus of the vestibulum. It was not possible to obtain intraoral photographs or radiographs. chlorhexidine gluconate (0.2% solution) and metronidazole tablets, 200 mg twice daily for 15 days were prescribed. The child was seen every alternate day for 10 days and her condition improved rapidly. halitosis had subsided. She was then referred to the Johannesburg Hospital for further treatment under general anaesthesia. The proposed treatment plan was as follows: removal of dental accretions and polishing of all teeth, extraction of the left maxillary teeth supported by non-vital bone, resection of the necrotic bone in the left maxilla and reconstructive surgery in the left cheek.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
2/8. Report of an infant with noma (cancrum oris).Noma (cancrum oris) is an infectious disease that destroys the oro-facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero-necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2-16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, hiv infection, and immune compromise conditions. poverty is the most important risk factor. We report the case of a 6-month-old child with noma and review the characteristic features of this disease.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
3/8. pseudomonas sepsis with Noma: an association?We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
4/8. Noma: life cycle of a devastating sore - case report and literature review.Noma (cancrum oris) is an orofacial gangrene, which during its fulminating course causes progressive and mutilating destruction of the infected tissues. The disease occurs mainly in children with malnutrition, poor oral hygiene and debilitating concurrent illness. Noma is well documented in the literature, but because most patients do not report to a doctor until the disease is at an advanced stage, its onset and progression remain a mystery. This case report, with a survey of recent relevant literature, highlights the different stages in the development of tissue necrosis, including onset and progression, with an emphasis on the need for early diagnosis and prompt treatment.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
5/8. Necrotizing stomatitis in the developed world.We present a case of a malnourished 68-year old man with occult hypothyroidism who presented with malaise, pyrexia, tongue swelling, oral ulceration and dysphagia after a 6-month period of increasing lethargy and failing self-care. Severe necrotic oral ulcerative lesions were accompanied by cutaneous purpura, blood-filled blisters and bedsores. It was concluded that the patient's clinical condition reflected necrotizing stomatitis on a background of malnutrition with scorbutic skin lesions and hypothyroidism. The patient made a good recovery with scrupulous oral hygiene, debridement, intravenous metronidazole and nutritional support. Healing occurred with marked fibrosis and trismus, which has slowly improved with mouth-opening exercises. Necrotizing stomatitis is more commonly encountered in malnourished children in developing countries, and may subsequently result in devastating facial defects and death. patients in the developed world with poor oral hygiene, malnourishment and immunosuppression are also at risk, but early diagnosis and treatment is life-saving and reduces subsequent disability.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
6/8. Cancrum oris-like lesions.Cancrum oris is predominantly seen in children in underdeveloped countries where widespread malnutrition, dehydration and epidemic infections are present. In the western world, it is sometimes found in immunosuppressed adults with predisposing conditions such as leukaemia and infection associated with malnutrition. early diagnosis and an intensive therapeutic approach are the key to a favourable prognosis of noma-like necro-ulcerative lesions. The prognosis is significantly improved if the predisposing condition can be removed. Two cases are presented and the treatment is discussed.- - - - - - - - - - ranking = 2keywords = malnutrition (Clic here for more details about this article) |
7/8. Noma in an unusual case of perforated appendicitis with pneumoperitoneum.Noma is a very rare gangrenous infection of the oral cavity usually associated with debilitating diseases, immunosuppression, or malnutrition. Its development in a previously healthy 13-year-old boy with perforated appendicitis is presented. streptococcus bovis type II and E coli were isolated from the noma and streptococcus bovis, bacteroides fragilis, and Bacteroides asacharolyticus from the peritoneal fluid. A transient impaired immune cellular function was found and may have contributed to the development of the noma in this child.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |
8/8. Noma.We report a case of noma in a debilitated 71-year-old white man. Predisposing factors included malnutrition, preleukemic syndrome, and occult renal adenocarcinoma. The superior third of the patient's lower lip was destroyed before he died.- - - - - - - - - - ranking = 1keywords = malnutrition (Clic here for more details about this article) |