Noma, a neglected disease: A viewpoint article

Farley, Elise; Ariti, Cono; Amirtharajah, Mohana; Kamu, Charity; Oluyide, Bukola; Shoaib, Muhammad; Isah, Shafiu; Adetunji, Adeniyi Semiyu; Saleh, Fatima; Ihekweazu, Chikwe; Pereboom, Monique; Sherlock, Mark

doi:10.1371/journal.pntd.0009437

Cited by 16 publications

(22 citation statements)

References 9 publications

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“…There is appreciation among the small community of clinicians and researchers involved in noma care and research that this lack of awareness impacts on the ability to develop and implement sound evidence-based policies and public health initiatives aimed at eradicating noma from communities that continue to be afflicted by this ancient disease. Several studies have stated that these gaps in research could be filled with better awareness about the disease and call for the inclusion of noma in the WHO list of neglected tropical diseases which would highlight noma in the global health arena [ 178 – 180 ]. It is likely that addressing the causes and conditions contributing to noma will lead to wide ranging benefits.…”

Section: Discussionmentioning

confidence: 99%

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

Farley

Mehta

Srour³

et al. 2021

PLoS Negl Trop Dis

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Background Noma (cancrum oris) is an ancient but neglected and poorly understood preventable disease, afflicting the most disenfranchised populations in the world. It is a devastating and often fatal condition that requires urgent and intensive clinical and surgical care, often difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and identify research gaps that need to be addressed to evolve our understanding of how to address this disease. Methods We searched 11 databases and collected primary peer reviewed articles on noma in all languages, the final search was conducted on 24th August 2021. The oldest manuscript identified was from 28th March 1843 and the most recently published manuscript was from 3rd June 2021. Search terms included cancrum oris and noma. Data was extracted using a standardised data extraction tool and key areas of interest were identified. The Preferred Reporting Items for Systemic review and Meta-Analyses requirements were followed. Results The review included 147 articles, the majority of the studies (n = 94, 64%) were case reports. Most manuscripts (n = 81, 55%) were published in the 2000s, 49 (33%) were from the 1900s and 17 (12%) from the 1800s. The main areas of interest identified were the history and epidemiology of the disease, noma’s clinical progression and aetiology, treatment regimens, mortality rates and the risk factors for the development of noma. Conclusions Noma has been reported in the literature for hundreds of years; however important gaps in our understanding of the disease remain. Future research should focus on determining the burden and distribution of disease; the true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.

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Section: Discussionmentioning

confidence: 99%

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

Farley

Mehta

Srour³

et al. 2021

PLoS Negl Trop Dis

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“…Acquired structural asymmetry includes trauma, neoplastic diseases and infections. Infectious diseases such as Noma [116][117][118] and facial skin tuberculosis [119] have been a common cause of facial disfigurement and still occur. Today, disfiguring infections of the facial soft tissues can successfully be prevented by avoiding predisposing factors such as malnutrition or can be treated with antibiotics.…”

Section: Acquired Structural and Functional Asymmetries Of The Head And Facementioning

confidence: 99%

Symmetry and Aesthetics in Dentistry

Runte

Dirksen

2021

Symmetry

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Animal bodies in general and faces in particular show mirror symmetry with respect to the median-sagittal plane, with exceptions rarely occurring. Bilateral symmetry to the median sagittal plane of the body also evolved very early. From an evolutionary point of view, it should therefore have fundamental advantages, e.g., more effective locomotion and chewing abilities. On the other hand, the recognition of bilaterally symmetric patterns is an important module in our visual perception. In particular, the recognition of faces with different spatial orientations and their identification is strongly related to the recognition of bilateral symmetry. Maxillofacial surgery and Dentistry affect effective masticatory function and perceived symmetry of the lower third of the face. Both disciplines have the ability to eliminate or mitigate asymmetries with respect to form and function. In our review, we will demonstrate symmetric structures from single teeth to the whole face. We will further describe different approaches to quantify cranial, facial and dental asymmetries by using either landmarks or 3D surface models. Severe facial asymmetries are usually caused by malformations such as hemifacial hyperplasia, injury or other diseases such as Noma or head and neck cancer. This could be an important sociobiological reason for a correlation between asymmetry and perceived disfigurement. The aim of our review is to show how facial symmetry and attractiveness are related and in what way dental and facial structures and the symmetry of their shape and color influence aesthetic perception. We will further demonstrate how modern technology can be used to improve symmetry in facial prostheses and maxillofacial surgery.

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“…According to [ 1 , 21 , 22 ] and the World Health Organization [ 7 , 23 ] noma can be classified into five stages: Stage 1: acute necrotising ulcerative gingivitis. Stage 2: oedema.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, to list ‘oedema’ as a ‘stage’ of noma [ 1 , 21 – 23 ] is nonsensical because oedema is a component of any inflammatory response. One might as well, and equally incorrectly, list as stages of noma any of the other signs of inflammation: erythema, heat, pain and restriction of function.…”

Section: Introductionmentioning

confidence: 99%

Noma staging: a review

Khammissa

Lemmer

Feller³

2022

Trop Med Health

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Noma is a bacterial, non-communicable, grossly destructive and disfiguring necrotising oro-facial disease. It is rare, but occurs most commonly in chronically malnourished children with other debilitating illnesses, in remote, poverty-stricken communities, mainly in sub-Saharan Africa, and much more rarely in central Latin America and in parts of Asia. In South Africa and in Zimbabwe, noma is observed, again rarely, in immunosuppressed HIV-seropositive subjects. The World Health Organization (WHO) has classified noma into five sequential stages: stage 1, acute necrotising ulcerative gingivitis; stage 2, oedema; stage 3, gangrene; stage 4, scarring; stage 5, sequela. In the opinion of the authors, this WHO classification requires fundamental re-appraisal. The purpose of this viewpoint article is to highlight the weaknesses of this classification, and to propose a simpler, more logical and practical evidence-based staging of noma, which if used should improve the quality and value of future epidemiological data about noma.

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Noma, a neglected disease: A viewpoint article

Cited by 16 publications

References 9 publications

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021)

Symmetry and Aesthetics in Dentistry

Noma staging: a review

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