NOMA: A Preventable "Scourge" of African Children
NOMA: A Preventable "Scourge" of African Children
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DOI：
10.2174/1874210601004010201
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发表时间：
2010-01-01
影响因子：
1.3
通讯作者：
Ogbureke, Ezinne I.
中科院分区：
文献类型：
--
作者：
Ogbureke, Kalu U. E.;Ogbureke, Ezinne I.
Noma是一种严重的口腔面部坏疽，起源于口腔内的牙龈-口腔黏膜复合体，然后向外扩散，产生明显的破坏性溃疡。虽然现在发达国家很少报告坏疽病例，但它在第三世界国家的儿童中仍然很普遍，特别是在撒哈拉以南非洲，那里的贫困、无知、营养不良和可预防的儿童感染仍然很常见。这篇综述总结了坏疽的历史、流行病学、管理和研究进展，并对其预防和最终全球根除提出了建议。全球每年的发病率仍然很高，约为14万例，未经治疗的疾病死亡率超过90%。在患者存活的地方，坏疽缺陷会导致难看的面部毁容、严重的疤痕、三叉神经症、口腔功能不全和社交疏远。虽然长期以来，病原学一直被认为是传染性的，但所引用的微生物与坏疽之间的确切因果关系一直很难确定。治疗伴有活动性疾病的坏死瘤需要抗生素和重建手术。目前的研究工作集中于全面了解诺曼病的流行病学，并进一步阐明诺曼病的微生物学和发病机制。尽管诺曼病是一项艰巨的公共卫生挑战，但可以预防，并有可能随后在全球范围内根除。为了实现这两个理想的目标，早期疾病的发现是至关重要的，因为当这些早期病变与营养康复并存时，对传统的抗生素治疗有反应，并避免了通常在晚期疾病中显示的广泛手术重建的必要性。20世纪中叶发达国家消灭坏疽证实了在非洲采取有效的预防战略后也会出现类似结果的想法。实现这一目标的一个根本和必要步骤是，国际社会将坏疽视为一项紧迫的全球公共卫生挑战。破译坏疽的微生物学、分子事件和发病机制的研究工作也应该加强。
Noma is a serious orofacial gangrene originating intraorally in the gingival-oral mucosa complex before spreading extraorally to produce a visibly destructive ulcer. Although cases of noma are now rarely reported in the developed countries, it is still prevalent among children in third world countries, notably in sub-Sahara Africa, where poverty, ignorance, malnutrition, and preventable childhood infections are still common. This review summarizes historical, epidemiological, management, and research updates on noma with suggestions for its prevention and ultimate global eradication. The global annual incidence remains high at about 140,000 cases, with a mortality rate exceeding 90% for untreated diseases. Where the patients survive, noma defects result in unsightly facial disfigurement, intense scarring, trismus, oral incompetence, and social alienation. Although the etiology has long been held to be infectious, a definitive causal role between microorganisms cited, and noma has been difficult to establish. The management of noma with active disease requires antibiotics followed by reconstructive surgery. Current research efforts are focused towards a comprehensive understanding of the epidemiology, and further elucidation of the microbiology and pathogenesis of noma.Although a formidable public health challenge, noma can be prevented with a potential for subsequent global eradication. To achieve both desirable goals, detection of early disease is crucial because these early lesions respond to conventional antibiotic treatments when instituted side by side with nutritional rehabilitation, and obviates the necessity for extensive surgical reconstruction often indicated in late stage disease. The eradication of noma in the developed world in the mid 20th century bears out the notion of a similar outcome following effective preventive strategies in Africa. A fundamental and necessary step towards attaining this goal is for the international community to adopt a perception of noma as an urgent global public health challenge. Research effort toward deciphering the microbiology, molecular events, and pathogenesis of noma also should intensify.