NEW YORK (Reuters Health) – Noma, a gangrenous infection of the face, may go untreated for well over a decade, reflecting the incidence and prevalence of the disease and the ability of existing surgical care systems to provide treatment, researchers say.
Noma primarily affects severely malnourished children, Dr. David Shaye of Massachusetts Eye and Ear in Boston told Reuters Health.
“While Noma is mostly seen in areas with low immunization rates and endemic malnutrition, it occurs sporadically around the world,” he said by email.
“A (misconception) is that it is a tropical disease,” he noted. “In fact, it only disappeared from Europe in the 19th century and a resurgence was reported in Auschwitz concentration camps in WWII.”
“Today, noma is primarily seen within the regions of Africa and Asia where chronic malnutrition exists,” he said. “A lack of meaningful statistics in these areas makes the extent of the problem truly unknown.”
As reported online April 12 in JAMA Facial Plastic Surgery, to get a sense of the disease burden, Dr. Shaye and colleagues analyzed data from a Doctors Without Borders intervention in northern Nigeria that provided facial reconstructive surgery to 18 patients referred to Sokoto Children’s Noma Hospital.
The team found a mean of 14.5 years (range, 2.0-40.5) between the onset of acute noma and surgical treatment.
“This prolonged delay is consistent with the known burden of disease,” the authors state.
“The fight against noma extends beyond the operating room, to early recognition and education programs to increase awareness,” Dr. Shaye said.
“The existence of noma in the 21st century is a reflection of the inequitable distribution of basic health and food resources in our world,” he added. “It is imperative that all countries not only assist these patients, but work to examine the root causes of noma.”
“In the end,” he concluded, “the eradication of noma will not be a medical accomplishment; it will come from ending hunger and poverty, which requires a change in how we treat each other as human beings.”
Dr. Christine Salvatore, chief of pediatric infectious diseases at NewYork-Presbyterian Komansky Children’s Hospital in New York City, told Reuters Health by email, “The lower socio-economic status and impoverished areas in the U.S. overall cannot be compared to those of the developing countries, where severe malnutrition is still a health priority and access to medical facilities can be non-existing and significantly delayed.”
Nonetheless, she noted, “Recently, there have been however a few reports in the HIV population, in patients with cyclic neutropenia, and leukemia.”
“The causes are not well understood,” she said, “but are thought to be multifactorial, and prompt initiation of antibiotics are of vital importance.”
“Clinicians need to know that the first recognized sign of noma is edema of the cheeks, or gingiva or both,” she explained. “A greyish black area then appears on the external surface of the cheek within the next few days and this is followed by a well-defined black necrotic zone. This is the start of the spread toward the deeper aspects of the oral cavity (and) can be associated with fever.”
“Recognizing these first signs in a child with malnutrition and poor oral hygiene and prompting supportive care and antibiotics administration can prevent a fatal outcome or the severe complications such as trismus, sequestration of jaws, fibrous ankylosis of temporomandibular joint, oro-nasal fistula, damage to permanent teeth and hypoplasia of maxilla or mandible and severe cosmetic disfigurement, which would require surgical procedures,” Dr. Salvatore concluded.
The work by Dr. Shaye and colleagues won an AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) award.
SOURCE: http://bit.ly/2JZMfxF
JAMA Facial Plast Surg 2018.
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