Pathogenesis of cancrum oris (noma): Confounding interactions of malnutrition with infection

This study showed that impoverished Nigerian children at risk for cancrum o ris (noma) had significantly reduced plasma concentrations of zinc (< 10.8 mu mol/L), retinol (< 1.05 mu mol/L), ascorbate (< 11 mu mol/L), and the es sential amino acids, with prominently increased plasma and saliva levels of free cortisol, compared with their healthy counterparts. The nutrient defi ciencies, in concert with previously reported widespread viral infections ( measles, herpesviruses) in the children, would impair oral mucosal immunity . We postulate, subject to additional studies, that evolution of the oral m ucosal ulcers including acute necrotizing gingivitis to noma is triggered b y a consortium of microorganisms of which Fusobacterium necrophorum is a ke y component. Fusobacterium necrophorum elaborates several dermonecrotic tox ic metabolites and is acquired by the impoverished children via fecal conta mination resulting from shared residential facilities with animals and very poor environmental sanitation.