Noma (disease)

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Classification according to ICD-10
A69.0 Necrotizing ulcer stomatitis
- noma
- gangrenous stomatitis
ICD-10 online (WHO version 2019)

Noma or cheek burn (also: gangrenous stomatitis , stomatitis gangraenosa , cancrum oris and water cancer ) is a serious bacterial disease that develops on the oral mucosa and from there eats away other soft and bony parts of the face . The WHO estimates that between 80,000 and 90,000 children die from this disease each year . Because of the peculiarity of this disease, there are no reliable surveys to date. In the Democratic Republic of the Congo (with around 72 million inhabitants) z. B. there are still no determinations of the prevalence at all .

causes

Noma (drawing by Robert Froriep) 1836

Noma usually affects children in developing countries where the immune system is already weakened due to malnutrition , previous illnesses (e.g. measles , mumps , rubella , meningitis ) and / or poor (oral) hygiene . The precursor of the 70 to 90% fatal disease is necrotizing ulcerative gingivitis (NUG) . According to estimates, there are around 14 sick people per 100,000 inhabitants in Niger . There were also repeated cases of illness in the concentration camps of the Third Reich or in Russian prisoner-of-war camps.

The disease is triggered by bacteria such as fusobacterium , spirochetes , borrelia , pseudomonads and enterococci .

Most affected are children under six years of age. This age range corresponds to the time between weaning from breast milk and piercing your teeth . With the weaning of breast milk, the maternal immune coverage is stopped and the safe supply, which is so urgently needed when changing teeth, is interrupted. From this point on, the children are forced to take part in the meals together .

The target group susceptible to noma, however, can be found in the socially disadvantaged to completely impoverished families, in which regular meals are not usual or not enough food is available (such as in developing countries). Due to the prolonged hunger or miscarriage or malnutrition (eg, protein deficiency ), the immune system is weakened. The lack of proteins , vitamins and electrolytes are particularly noticeable here .

Even if children are almost always mentioned in Noma, this is not exclusively the case. The described causes promoting noma also apply to adults, but it does not occur that often, as the immune system is usually somewhat stronger due to advanced age, in contrast to the phase of weaning from breast milk . Other, but similar factors play a role here: the combination of the life situation (e.g. stress , war , loss of breadwinner), previous infectious diseases , malnutrition and poor hygienic conditions .

Complaints and symptoms

Noma is a bacterial disease caused by malnutrition or malnutrition and a weakening of the immune system caused by it , which leads to the destruction of the oral mucosa , face and bones . Bacteria and germs of the oral flora can no longer be kept in check by a severely weakened immune system, and the oral flora gets out of control.

There are four stages:

A man suffering from noma

Stage 1: bleeding gums and bad breath . Red-bluish, hard lump on the lining of the mouth that becomes inflamed and spreads over the lining of the mouth, cheek and lips .

Stage 2: The inflamed parts of the face swell. The affected area becomes thick and hard. Fever and pain occur. Pus forms on the affected areas , and the smell becomes unbearable.

Stage 3: The swelling develops into tissue decomposition . The affected area forms a black zone, which is bordered with a whitish line, which indicates the next loss of tissue. This phase is accompanied by fever, diarrhea and a deterioration in the general condition .

Stage 4: This is the main phase of the noma. The patient's general condition has deteriorated considerably. The loss of tissue affected the lip, cheek, bony eye socket , and sometimes even all parts of the face together. Death occurs in untreated victims from necrosis , blood poisoning , pneumonia, or bloody diarrhea.

The consequences of noma can be devastating. Noma leads to mutilations through scars , which burden and hinder man all his life. This often leads to social exclusion from the village community , to the repudiation and orphanage of the children, who are often excluded from playing with other children. Children with a noma do not stand on the street and usually do not report to the hospital by themselves , but live “hidden” for fear of discrimination , in that they are hidden from their mothers or other relatives.

Noma is not on the WHO list, according to which the WHO determines diseases and their spread in the world. Since the victims live in hiding, the cases of illness do not appear in any statistics.

treatment

Stage 1: In this phase, local antiseptic mouthwashes, a diet improvement or change, in particular the supply of vitamins and proteins, are sufficient for the treatment .

Stage 2: This phase requires therapeutic treatment: swab removal to determine the bacterial accumulation present , treatment with antibiotic combination preparation and retention of the mouth rinses (metronidazole and chlorhexidine).

Step 3: This phase makes immediate Noternährung required, the supply of liquid and equalization of the electrolyte balance . Even in this phase, noma can still be controlled through the targeted use of antibiotics (in connection with nutritional improvement ). For the treatment of the noma, this stage is crucial and very dangerous, as the necessary medication is often lacking in developing countries . The urgently needed admission to the hospital can usually not be guaranteed due to the lack of or inaccessible roads, so that emergency treatment often comes too late. As a result, the tumor separates from the facial bone, and sometimes the bone itself.

Level 4: At this level, the death rate is very high. The earlier sick children can be discovered and treated, the better the chances of success in saving them from death. The children die primarily of blood poisoning . After successful treatment, scarring begins. Due to the shrinkage of the soft and bone parts , this leads in most cases to the jaw clamp , so that the subsequent oral nutrition is excluded. The children who have not previously died of blood poisoning die then through starvation and dying of thirst . Another dangerous situation arises when vomiting of children because of the risk to the vomit of choking .

Consequences and complications

Those affected not only suffer from physical symptoms , but also from psychological and social problems, for example:

See also

In Switzerland, the non-profit aid organization Noma-Hilfe-Schweiz was founded in 2005 in Küsnacht ZH. One of the founding members was Bertrand Piccard. The aim of the association is the fight against noma mainly in the areas of prevention by means of education and awareness raising, but also with direct help thanks to plastic-reconstructive surgery.

literature

Karl Günter Wiese, Hans-Albert Merten, Simon Brami u. a .: Noma - the unknown disease. Zahnärztliche Mitteilungen 92, No. 4, February 16, 2002, ( HTML version of the article , PDF file of the complete journal , 2 MB)

Web links

Commons : Noma (Disease)  - Collection of pictures, videos and audio files

Individual evidence

  1. a b Jean Ziegler : We let them starve to death. The mass destruction in the third world. C. Bertelsmann Verlag, Munich 2012, ISBN 978-3-570-10126-1 , chapter “The Noma Tragedy”, pp. 85–95.