CANCRUM ORIS

SOYEBO OLUSEYE alegra

OUTLINE
} INTRODUCTION } EPIDEMIOLOGY } ORGANISMS } PREDISPOSING } PATHOGENESIS } MANAGEMENT } CONCLUSION

FACTORS

INTRODUCTION
NOMA & GANGRENOUS STOMATITIS } Is a devastating disease characterized by the destructive process of the oro-facial tissues. } is a rapidly progressive, polymicrobial, opportunistic infection that occurs during periods of compromised immune function.
} a.k.a

EPIDEMIOLOGY
} In

Sub Saharan Africa, it is seen in children 3-10 years. In Nigeria, prevalence among children is 23% related NOMA prevalence 4.3-16.0%

} AIDS

ORGANISMS
necrophorum } Borrelia vincenttii } Staphylococcus aureus } Prevotella intermedia
} Fusobacterium

PREDISPOSING FACTORS
malnutrition } Poverty } Immunosuppression } Poor oral and general hygiene } Infectious diseases e.g. measles, chicken pox, T.B etc. } smoking
} Severe

PATHOGENESIS
starts within the oral cavity progressing from untreated Acute Necrotizing Ulcerating Gingivitis (ANUG): - halitosis, bleeding gum, painful gum and pseudomembranous ulcers. } The Bacteroides produce a range of destructive metabolites such as collagenase, fibrinolysin, endotoxins, hydrogen sulfide, Indole ammonia fatty acids, protease. } The ulcers are covered with whitish- yellow or brown fibrin and debris.
} Noma

} The

gangrenous necrosis progressively involves the buccae, the lips, and the adjacent bone, producing catastrophic lesions on the face.
}

CLINICAL FEATURES

} Salivation,

halitosis, fever, malaise, and regional lymphadenopathy. } Facial edema } cheek, chin, infraorbital margin, palate, nose, antrum or any part of the face may be affected } Marked fetid oral odor = H2S, Indole, Ammonia

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DIAGNOSTIC PATOLOGY
} Fusiform

Necrophorum is a cigar shaped organism Gram positive 5-12micron in length with a straight or slightly curved axis. Easily decolorized on Gram stain and is non motile. } Cultured anaerobically on serum agar or serum broth } The culture is pleomorphic and the organism has little effect on laboratory animals.

} Borelli

Vincentia measures 5-10micron in length } Has 3-8 irregular spirals } It is actively motile } Gram negative and stains poorly } It can be demonstrated in fresh material by dark ground examination } Cultured anaerobically on serum agar or serum broth } No effect on guinea pig

} Inoculation

of both organism though produces infection } In summary, these organisms can be demonstrated on smears from ulcerated lesion s by gram stain , dark ground examination is also useful } Culture and animal inoculate are further diagnostic procedures.

PREVENTION
}

} }

} }

Will require measures that address these problems, and also importantly, eliminate fecal contamination of foods and water supplies. Adequate diet for young children (weaning) Brushing the teeth, keeping the mouth clean to prevent development of gum ulcers, NUG that leads to Noma. Parental education Training health care workers to recognize the early symptoms and give emergency care

MANAGEMENT
} }

Begins with proper history which reveals age, habit and socioeconomic level among others Proper examination will reveal symptoms of malnutrition via fluffy hair, thinned out muscles etc. Local examination will reveal a grotesque ulcer whose base may be larger than the apex depending on the stage of presentation Proper investigation will either implicate or rule out underlying etiological factor

} Treatment

is broadly classified into immediate and

long term } In the immediate pain is controlled and the underlying causative factors are treated } Patients do well with combination of penicillin, aminoglycoside and metronidazole. } Local infection is controlled by wound debridement and dressing. } After full recovery of health, reconstruction surgery is required to prevent permanent mutilation.

CONCLUSION
management of Cancrum Oris is such an herculean task that the best method of management is preventive } This is the strategy WHO has put in place making the disease almost an history especially in previously endemic area
} The

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