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South African Dental Journal

versão On-line ISSN 0375-1562
versão impressa ISSN 0011-8516

Resumo

PEDRO, K; SMIT, D A  e  MORKEL, J A. Cancrum Oris (noma) in an HIV-positive adult: A case report and literature review. S. Afr. dent. j. [online]. 2016, vol.71, n.6, pp.248-252. ISSN 0375-1562.

BACKGROUND: Noma refers to an overwhelming invasion of micro-organisms from the oral cavity into the face leading to gangrene, sepsis and, possibly, death. Figures available for 2006 indicate an estimated incidence of 100 000 to 140 000 new cases each year in sub-Saharan Africa with a mortality rate of 70% to 90%. INTRODUCTION: The classic clinical picture of a noma patient is severe facial tissue destruction associated with oral ulcerations and, in some cases, acute necrotising gingivitis. The following case report concerns a 35-year-old female patient who was treated at the Department of Maxillo-Fa-cial and Oral Surgery at the Tygerberg Oral Health Centre. CASE REPORT: A 35- year old female was referred to the department with a gaping defect in her right cheek accompanied by necrosis of her mandible. Her medical history indicated that she was HIV+ and had previously been diagnosed with Multi-Drug Resistant TB (MDR). She had defaulted on treatment for both these diseases. Extra-oral examination revealed a gaping defect as a result of the loss of soft tissue of the right cheek. The patient was admitted so that her medical treatment regime could be optimized under supervision.. A biopsy of the exposed mandibular bone and soft tissue was done under local anaesthetic as the patient was considered an anaesthetic risk. The results indicated acanthosis with diffuse epidermal hyperplasia. DISCUSSION: Globally it appears that HIV infection is not a strong risk factor for noma. In South Africa, HIV infection may play a substantial role in the pathogenesis of noma. In this particular case there was severe facial tissue destruction associated with oral ulceration and acute necrotising gingivitis. An increase in the incidence of noma shows that it cannot be dismissed as a scourge of previous centuries, but remains a public health issue in the poorest communities of the world, still claiming thousands of victims annually. Hence the attempt to reduce the incidence of noma has become a priority for the World Health Organization's (WHO) five-point strategy. The goal of treatment during the acute stage aims to keep the patient alive by administering antibiotics and specific treatment for co-existing diseases. Once the initial stages have been overcome and a good nutritional status has been achieved, patients can be assessed for reconstructive surgical treatment. CONCLUSION: The clinical features of this case were consistent with classical features reported in the literature. It emphasizes how this condition contributes towards serious facial destruction and debilitation. This case also highlights a potential association between noma and HIV/AIDS.

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