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Cancrum oris, also called noma, is a destructive bacterial infection that attacks the tissue of the mouth and face. This disease, which is a form of gangrene, is not contagious and is seen mainly in children in developing countries. It is associated with malnutrition and a weak immune system. Early treatment with antibiotics and nutritional support may slow the spread of the disease.
Noma, the Greek word for devour, is a term used to describe the rapid tissue destruction of cancrum oris. Patients can develop large areas of dead tissue on the face which leads to severe disfigurement. This disfigurement can interfere with the patient's ability to eat or speak.
The highest incidence of noma is seen in children living in the African countries of Nigeria and Senegal, although this disease is also present in some countries of Asia and South America. Most of the patients who contract cancrum oris range in age from 1 to 4 years old. These patients live in areas of poor sanitation with unsafe drinking water, and often share their living quarters with domesticated livestock.
An outbreak of this gangrenous disease in a child usually appears after another viral or bacterial infection, such as measles or malaria. A weakened immune system, poor nutrition, and poor oral hygiene could lead to the formation of ulcers in the mouth. These ulcers provide an environment for bacteria to enter the tissues. A combination of bacteria that include species of Fusobacterium and Prevotella are believed to be the primary agents that cause cancrum oris. Enzymes and toxins released by these bacteria are responsible for tissue destruction.
Early symptoms of this disease include fever, swelling, and a foul odor coming from the mouth. These acute symptoms can rapidly progress until the bacteria have destroyed soft tissue, muscle, and bone. Many patients do not receive medical treatment during the acute symptoms, although early treatment with antibiotics can slow the progression of the disease.
Patients who do not receive medical treatment usually develop a severe disfigurement of the face and jawbone. They may see some benefit from surgical reconstruction after the condition has been treated, but full function is almost never restored. Cancrum oris has a high mortality rate.
Prevention is often considered the best way to deal with cancrum oris. Educating families about hygiene, nutrition, and sanitation is an important step in prevention. Encouraging mothers to breastfeed longer may also improve the nutritional and immune status of children in affected countries. Teaching families about the early symptoms of cancrum oris may allow patients to get antibiotic treatment quickly enough to prevent serious disfigurement or death.