Noma: a neglected scourge of children in sub-Saharan Africa.

Noma (cancrum oris) is a severe gangrene of the soft and hard tissues of the mouth, face, and neighboring areas observed especially in children. Without the timely intervention of appropriate antibiotics, noma is almost always quickly fatal. Survivors of the disease may exhibit facial mutilation, impaired growth of the facial skeleton, nasal regurgitation of food, leakage of saliva, defective speech, and chewing difficulties. Noma is frequently seen in developing countries, especially in sub-Saharan Africa, where it occurs almost exclusively among poor children usually aged 3-10 years. It may be that noma results from oral contamination by a heavy load of Bacteroidaceae and a consortium of other microorganisms. The opportunistic pathogens invade oral tissues when an individual's immune response is compromised by malnutrition, acute necrotizing, gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers. Accordingly, malnutrition, poor oral hygiene, and debilitation resulting from HIV infection, measles, and other childhood diseases prevalent in the tropics are factors associated with an increased probability of developing noma. Poverty, however, is the most important risk indicator for the condition. The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region. The prevention of noma in Africa will require measures which address these problems and, most importantly, eliminate the fecal contamination of food and water supplies.