2023-12-03 22:41:12
Introduction
Illustration de 1836
Noma (from the Greek numein: to devour) is a form of devastating gangrene which develops in the mouth and ravages the tissues of the face. It mainly affects young children (under 6 years old). Its causes being mainly lack of hygiene (Hygiene is a set of measures intended to prevent infections and…) and malnutrition (Malnutrition designates a pathological state caused by deficiency or…), noma is often associated with conditions of extreme poverty.
Historical
It was described by Tourdes in 1848. In 1776, Joseph Plenck cited it as an illness (Disease is an alteration of the functions or health of a living organism, animal…) observed in children of five years, most often in orphanages. It virtually disappeared from Europe at the end of the 19th century. The word comes from the Latin saeculum, i , which…), apart from a reappearance in certain concentration camps during the Second World War. Sporadic cases have been described in patients with AIDS.
Mechanism
An infectious origin was suspected as early as 1907. The lesion itself is full of various bacteria but which are also present on the skin. composed of several layers of tissue. She plays, among other things, the…) of malnourished children but free from noma. Certain bacteria, or even viruses (A virus is a biological entity which requires a host cell, which it uses…), might play a role in the genesis of the condition such as: Prevotella intermedia, Fusobacterium necrophorum, etc.
The role of poverty is predominant: more frequent during the dry season when the risk of famine is maximum, it does not has never been described in well-nourished children. The respective roles of undernutrition (Undernutrition is a pathological state resulting from nutritional intake…) and poor hygienic conditions, however, remain to be determined.
The role of an immune deficiency has been mentioned, which can be secondary to malnutrition but also consecutive to certain diseases (AIDS).
Epidemiology
The number of children affected in the world (The word world can designate:) is estimated to be around 500,000 per year. If they are not taken care of quickly with antibiotic therapy, the mortality rate is the number of annual deaths compared to the number…) can reach 80%. The condition mainly affects young children (1 to 4 years old) but later cases have been described.
Noma is present in all the countries (Country comes from the Latin pagus which designated a territorial and tribal subdivision of extent…) of the Third World, but particularly in Africa (With an area of 30,221,532 km2 including the islands,…) sub-Saharan where its incidence rate reaches 1 per 1,000 per year.
Evolution
The disease leads, without treatment, to death in nearly 80% of cases. Otherwise, it leaves serious functional following-effects (difficulty in chewing, speech, etc.), aesthetic and psychological (disfigurement).
Description
The disease mainly presents with extensive ulceration, most often unilateral, beginning at the gums and extending to the lips and cheek. the part of the face which covers the oral cavity, closed by the…). Ulceration commonly affects the underlying muscles, leaving a gaping wound which often reveals the bones. It occurs in a child in poor general condition, with signs of malnutrition.
Principles of treatment
Rehydration and refeeding remain imperative. The oral route (by mouth) is preferred but can be made difficult by the pain caused by the disease. The ulcer must be cleaned regularly with antiseptics. Antibiotics are given: metronidazole or other broad-spectrum antibiotics (effective on a wide variety of germs). Rehabilitation is necessary during healing in order to avoid problems opening the mouth (The mouth (also called oral cavity or oral cavity) is the opening through…). Surgical repair of facial lesions is difficult, with imperfect results.
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