Noma, a neglected tropical disease?

Noma is also known as necrotizing ulcerative stomatitis or cancrum oris, a severely debilitating orofacial infection. It has been known for centuries and was already reported by Hippocrates and other physicians of the time. The WHO estimates that 140,000 new noma cases occur globally each year, 770,000 patients are affected, mortality reaches 90%, and most cases are reported in low- and middle-income countries in Africa and Asia. However, these estimates are from 1998 and have evident limitations, and in addition there is a high number of undocumented and unreported cases. Therefore, the noma disease burden cannot be given with any degree of accuracy. While causes and pathogenesis are not fully understood, noma is a bacterial gangrene caused by multiple factors including poor oral hygiene, malnutrition, and deficient sanitary conditions. Children between the age of 2 and 6 years are at highest risk. No single bacterial species has been identified as the “sole” causative agent of Noma...