Enwonwu C O, Falkler W A, Idigbe E O, Savage K O
School of Dentistry, University of Maryland, Baltimore 21201, USA.
Oral Dis. 1999 Apr;5(2):144-9. doi: 10.1111/j.1601-0825.1999.tb00080.x.
Noma (cancrum oris) is an infectious disease which destroys the oro-facial tissues and other neighboring structures in its fulminating course. It affects predominantly children aged 2-16 years in sub-Saharan Africa where the estimated frequency in some communities may vary from one to seven cases per 1000 children. The key risk factors are poverty, malnutrition, poor oral hygiene, deplorable environmental sanitation, close residential proximity to livestock, and infectious diseases, particularly measles. Malnutrition acts synergistically with endemic infections in promoting an immunodeficient state, and noma results from the interaction of general and local factors with a weakened immune system as the common denominator. Acute necrotizing gingivitis (ANG) is considered the antecedent lesion. Current studies suggest that evolution of ANG to noma requires infection by a consortium of microorganisms with Fusobacterium necrophorum and Prevotella intermedia as the suspected key players. Without appropriate treatment, mortality rate is 70-90%. Survivors suffer the two-fold affliction of oro-facial disfigurement and functional impairment. Reconstructive surgery of the resulting deformity is time-consuming and financially prohibitive for the victims who are poor.
坏疽性口炎（走马疳）是一种传染性疾病，在其暴发性病程中会破坏口腔面部组织及其他邻近结构。它主要影响撒哈拉以南非洲地区2至16岁的儿童，在一些社区，估计发病率可能为每1000名儿童中有1至7例。主要风险因素包括贫困、营养不良、口腔卫生差、环境卫生恶劣、居住环境与牲畜近距离接触以及传染病，尤其是麻疹。营养不良与地方性感染协同作用，促进免疫缺陷状态的形成，坏疽性口炎是一般因素和局部因素与免疫系统减弱相互作用的结果，免疫系统减弱是共同特征。急性坏死性龈炎（ANG）被认为是前期病变。目前的研究表明，ANG演变为坏疽性口炎需要由一组微生物感染，其中坏死梭杆菌和中间普氏菌被怀疑是关键因素。若不进行适当治疗，死亡率为70%至90%。幸存者会遭受口腔面部毁容和功能障碍这双重折磨。对于贫困的受害者来说，对由此产生的畸形进行重建手术既耗时又费用高昂。
