Signs, Symptoms, and Stages of Noma
- Noma begins as an ulcer on the gums and rapidly spreads to the jawbone, cheek, and soft tissues of the face.
- It results in severe facial disfigurement, impairments in breathing, swallowing, speaking, and vision.
- Noma neonatorum is a severe infection affecting newborn children, spreading across the oral, nasal, and/or anal areas.
- Symptoms include painful, bleeding gums, facial edema, foul breath, and tissue destruction.
- Many patients die due to sepsis, while survivors are left with permanent scarring and disfigurement.
- The World Health Organization divides Noma into five stages: acute necrotizing gingivitis, edema, gangrenous, scarring, and sequelae.
- Stage I: Acute necrotizing gingivitis is characterised by red or reddish-purple gums, spontaneous bleeding, and painful ulcers.
- Stage II: Edema shows facial swelling, worsening gum ulceration, soreness, fever, and difficulty eating.
- Stage III: Gangrene leads to tissue destruction, holes in the face, and exposure of bones and teeth.
- Stage IV: Scarring includes trismus, scar formation, and setting of exposed teeth.
Epidemiology and Risk Factors of Noma
- Noma predominantly affects children between the ages of two and six in the least developed countries, primarily in sub-Saharan Africa.
- Accurate figures for Noma prevalence are not available, but in 1998, WHO estimated 140,000 new cases per year with a 90% fatality rate.
- Noma is associated with a high morbidity rate and a mortality rate of approximately 90% without treatment.
- With access to medical care, the mortality rate drops to under 10%.
- The disease is linked to extreme poverty, malnutrition, immunosuppression, underlying infections, and poor oral health.
- Predisposing factors include malnutrition, vitamin deficiency, immunodeficiency, poor oral hygiene, recent illness, and social/environmental factors.
- Noma primarily affects malnourished children between 2 and 6 years old, but cases have also been reported in malnourished or immunosuppressed adults.
- Concentration camps during the Second World War also reported cases of Noma.
Treatment and Prevention of Noma
- Early stages of Noma can be treated effectively with antibiotics and nutrition supplements.
- Proper wound healing can occur if diagnosed early enough.
- After recovering, patients with disfigurement require complex surgical rehabilitation.
- Reconstructive surgery is an option for patients in the sequelae stage.
- Education and community outreach programs can help counter the stigma, social isolation, and discrimination faced by Noma survivors.
- Treatment of noma involves a multidisciplinary approach, including surgical intervention, antibiotics, and nutritional support.
- Reconstructive surgery aims to restore facial function and appearance.
- Prevention strategies for noma include improving nutrition, promoting oral hygiene, and providing access to healthcare.
- Vaccination against diseases like measles and tetanus can reduce the risk of noma.
- Community education and awareness programs are essential for early recognition and prevention of noma.
History and Etymology of Noma
- Noma was known to physicians such as Hippocrates and Galen in antiquity.
- The first clinical description of noma was in 1595 by Carolus Battus.
- Dutch surgeon Cornelis van de Voorde coined the term 'noma' in 1680.
- Gabriel Lund attributed noma to poverty, cramped living conditions, and malnutrition in 1765.
- Surgical treatments for noma sequelae developed throughout the 1800s.
- The word 'noma' comes from the classical Greek word 'νομή.'
- 'Noma' was used to describe the continuing process of a fire or an ulcer.
Impact, Support, and Sociocultural Factors of Noma
- People with noma may face stigma and be avoided due to the misconception that it is contagious.
- Afflicted children may be hidden within the home due to social stigma.
- Some believe noma may be caused by witchcraft or a curse.
- Noma is a disease of shame, and children are sometimes hidden instead of receiving treatment.
- Traditional medicine may be sought instead of medical centers in Nigeria.
- Noma's physical effects are permanent and may require oral and maxillofacial surgery or reconstructive plastic surgery.
- Noma survivors may face stigma and discrimination.
- Roughly 770,000 people worldwide live with noma sequelae.
- Charitable organizations like Facing Africa and Winds of Hope provide support to noma survivors in Africa.
- The Noma Children Hospital Sokoto in Nigeria specializes in treating noma patients.
Noma (also known as gangrenous stomatitis or cancrum oris) is a rapidly progressive and often fatal gangrenous infection of the mouth and face. Noma usually begins as an ulcer on gums and rapidly spreads into the jawbone, cheek, and soft tissues of the face. This is followed by death of the facial tissues and fatal sepsis. Survivors are left with severe facial disfigurement and impairments in breathing, swallowing, speaking and vision. In 2023 noma was added to the World Health Organization's list of neglected tropical diseases.
| Noma | |
|---|---|
| Other names | cancrum oris, stomatitis gangrenosa |
 | |
| Stage 3 noma (gangrenous stage) in a young girl | |
| Specialty | Pediatrics, otorhinolaryngology, dentistry  |
| Symptoms | Facial edema, fever, gangrene of face |
| Complications | sepsis & death, facial disfigurement, difficulty eating/drinking, social stigma |
| Usual onset | age 2-6 years |
| Duration | acute phase lasts 2-4 weeks |
| Causes | Opportunistic infection |
| Risk factors | Extreme poverty, malnutrition, immunosuppression |
| Diagnostic method | Based on symptoms |
| Differential diagnosis | Oral cancer, leishmaniasis, leprosy |
| Prevention | Adequate nutrition, oral hygiene |
| Treatment | Antibiotics, nutritional supplements, oral hygiene |
| Medication | antibiotics |
| Prognosis | 90% fatality rate without treatment |
| Frequency | 140,000 new cases per year (1998 estimate) |
This disease is strongly linked to poverty and malnutrition, and predominantly affects children between the ages of two and six years in the least developed countries around the world, primarily in sub-Saharan Africa; noma has also been seen in severely immunocompromised people in the developed world. It is preventable by proper nutrition and oral hygiene. Noma is most common in impoverished environments with poor healthcare infrastructure; as a result many cases go undiagnosed, untreated and unreported. There are no reliable estimates of its prevalence - in 1998 WHO estimated that there were 140 000 cases per year with a fatality rate of 90%; no more recent estimates are available.
Noma is an opportunistic infection linked to a number of microbes which take advantage by malnutrition and compromised immunity. There is no evidence of direct transmission from person to person. In the early stages, it can be treated effectively with antibiotics and nutrition supplements. If diagnosed early enough, there can be proper wound healing. After recovering, patients with disfigurement require complex surgical rehabilitation.
Noma survivors experience high levels of stigma, social isolation, and discrimination within their communities. These can be countered by education and community outreach programmes.
