Microbiological understandings and mysteries of noma (cancrum oris)

The microbiologic history of noma was reviewed. Studies have associated the disease process with large numbers of fusiform bacilli and spirochetal org anisms, In order to study the microbiology of the staging and infection per iods of noma 62 Nigerian children, aged 3-14 years, 22 children had acute n ecrotizing ulcerative gingivitis (ANUG) and were also malnourished, 20 exhi bited no acute necrotizing ulcerative gingivitis hut were malnourished and 20 were free of acute necrotizing ulcerative gingivitis and in good nutriti onal state) were evaluated for the presence of viruses and oral microorgani sms. The ANUG cases in the malnourished children had a higher incidence of Herpesviridae, the main virus being detected was cytomegalovirus. There wer e more anaerobic microorganisms recovered, with Prevotella intermedia as th e predominant isolate, in the malnourished children as compared to the heal thy children. A study of the predominant microflora in active sites of noma lesions was carried out in eight noma patients, 3-15 years of age, in Soko to State, northwestern Nigeria. Fusobacterium necrophorum was recovered fro m 87.5% of the noma lesions. Oral microorganisms isolated included Prevotel la intermedia, alpha-hemolytic streptococci and Actinomyces spp. which were isolated from 75.0, 50.0 and 37.5% of the patients, respectively. Peptostr eptococcus micros, Veillonella parvula, Staphylococcus aureus and Pseudomon as spp. were each recovered from one lesion. All strains were observed to b e sensitive to all of the antibiotics tested with the exception of one stra in of P. intermedia which showed resistance to penicillin. The pathogenic m echanisms of F. necrophorum as a trigger organism were discussed. The isola tion from human noma lesions of F. necrophorum, a pathogen primarily associ ated with animal diseases, may have important etiologic and animal transmis sion implications.