(from Greek numein
: to devour) also known as cancrum oris
or gangrenous stomatitis
, is a gangrenous disease
leading to tissue
destruction of the face, especially the mouth
Exact etiology is not known, but noma is likely caused by bacterial infection, specifically by fusospirochetal organisms. Risk factors include severe protein malnutrition (e.g. Kwashiorkor
) and unsanitary conditions.
Presentation and prognosis
The mucous membranes
of the mouth develop ulcers
, and rapid, painless tissue degeneration ensues, which can degrade tissues of the bones in the face.
In a condition sometimes called noma pudendi, noma can also cause tissue damage to the genitals.
The disease is associated with high morbidity and mortality and mainly affects children under the age of twelve in the poorest countries of Africa. Children in Asia and some countries of South America are also affected. Most children who get the disease are between the ages of two and six years old. The WHO estimates that 500,000 people are affected, and that 100,000 new cases are reported each year.
Known in antiquity to such physicians as Hippocrates
, noma was once reported around the world, including Europe
and the United States
. With the improvement in hygiene and nutrition, noma has disappeared from industrialized countries since the 20th Century, except during World War II
when it was endemic to Auschwitz
. The disease and treatments were studied by Berthold Epstein
, a Czech inmate physician directed to do so by Josef Mengele
The progression of the disease can be halted with the use of antibiotics and improved nutrition; however, its physical effects are permanent and may require reconstructive plastic surgery to repair.
Despite the fact that more than 400,000 children are affected in Africa alone, there is only one noma hospital in all of Africa. Noma Children Hospital Sokoto is located in Nigeria and aside from the regular doctors, European and American medical teams travel there to perform operations. Without plastic surgery, the children's faces cannot be restored.