Noma, a neglected disease: a teaching article

Noma (cancrum oris) is a rapidly progressing infection of the oral cavity, associated with a reported 90% mortality rate within weeks after the onset of first symptoms, if left untreated. Noma mostly affects children aged between 2 and 5 years. Along with its high mortality rate, noma causes severe physical and mental health sequelae and affects those most vulnerable living in isolated communities with minimal access to healthcare. While the clinical manifestation and sequelae of noma in each case are unique, the infection invariably starts as an inflammation of the gums, which then leads to ulceration and the rapid destruction (within weeks) of the cheek, jaw, lip, nose and/or the eye. Noma is an ancient but neglected and poorly understood disease afflicting the most disenfranchised populations in the world. Noma has been reported in the literature for many 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, its true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment. The eradication of noma is possible with a global integrated approach. The addition of noma to the World Health Organization’s list of Neglected Tropical Diseases would increase awareness about the disease and provide the impetus for increased research and funding for prevention and treatment programmes.