Noma (disease)

Noma (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 and cheek.

Causes
Noma may be caused by bacteria called fusospirochetal organisms. Many children who develop the disease have had another illness such as measles, scarlet fever, tuberculosis, cancer, or immunodeficiency. Although the exact cause is not known, poor nutrition is a risk factor for the disease. It is not communicable.

History
Known in antiquity to such physicians as Hippocrates and Galen, 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 (in the section where the Nazis interned Gypsies) and Belsen.. The disease and treatments were studied by Berthold Epstein, a Czech inmate physician directed to do by Josef Mengele.

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. The disease degrades the faces of children within days.

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 (of around 80 per cent) 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 with 100,000 new cases each year.

Treatment
The disease is rarely treated since in some cultures it is considered taboo.

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.