Noma A69.00

A foudroyant infectious disease that occurs very rarely in industrialized countries. It often begins as a gingival infection, spreads rapidly and leads to progressive ulceration of the mouth and cheek area. In most cases, the infectious tissue destruction proceeds without a major defensive reaction. This results in large tissue defects of the facial region, which often include the cheek and lip regions, exposing the dental apparatus. Some authors regard the disease as fusospirochetosis.

Worldwide 100.000-300.000 diseases/year. In endemic areas (Sub-Sahara, Sahel) the incidence is 1-12/1,000 inhabitants/year. In the Federal Republic of Germany it occurs practically only sporadically in migrants or as a consequence of other infectious diseases such as typhoid, measles or HIV/AIDS.

Oral mixed infection (acute necrotizing gingivitis), especially colonization of the cavum oris with Fusobacterium necrophorum, F. nucleatum, Prevotella intermedia (> 80% of patients), Actinomyces spp. (40-80% of patients), Bacteroides, Streptococci spp. and Staphylococcus spp. Borrelia vincenti is regularly found in the diseased tissue.

Predisposing factors: malnutrition, immunosuppression (e.g. measles, varicella, HIV infection, CMV infection, herpes simplex), poor oral hygiene, living conditions with close contact to pets.

Penicillins are effective in early stages, better antibiosis after antibiogram (mixed infection). Also effective are tetracyclines, cephalosporins or ciprofloxacin. If necessary, glucocorticoids such as prednisolone (e.g. Decortin H) for glucocorticoid substitution.

In addition to rapid mortality (70-90% of untreated cases), milder courses are also known (Farley E et al. 2019).

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