Noma (disease)

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)

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 often with impairments in breathing, swallowing, speaking and vision.^[1][2][3][4] In 2023 noma was added to the World Health Organization's list of neglected tropical diseases.^[5]

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.^[1][2][3][4]

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.^[1][2][3][4]

Noma survivors experience high levels of stigma, social isolation, and discrimination within their communities. These can be countered by education and community outreach programmes.^[3]