• Denise Baratti-Mayer, Angèle Gayet-Ageron, Stéphane Hugonnet, Patrice François, Brigitte Pittet-Cuenod, Antoine Huyghe, Jacques-Etienne Bornand, Alain Gervaix, Denys Montandon, Jacques Schrenzel, Andrea Mombelli, Didier Pittet, and Geneva Study Group on Noma (GESNOMA).
• GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
• Lancet Glob Health. 2013 Aug 1; 1 (2): e87-e96.

BackgroundNoma is a poorly studied disease that leads to severe facial tissue destruction in children in developing countries, but the cause remains unknown. We aimed to identify the epidemiological and microbiological risk factors associated with noma disease.MethodsWe did a prospective, matched, case-control study in Niger between Aug 1, 2001, and Oct 31, 2006, in children younger than 12 years to assess risk factors for acute noma. All acute noma cases were included and four controls for each case were matched by age and home village. Epidemiological and clinical data were obtained at study inclusion. We undertook matched-paired analyses with conditional logistic regression models.FindingsWe included 82 cases and 327 controls. Independent risk factors associated with noma were: severe stunting (odds ratio [OR] 4·87, 95% CI 2·35-10·09) or wasting (2·45, 1·25-4·83); a high number of previous pregnancies in the mother (1·16, 1·04-1·31); the presence of respiratory disease, diarrhoea, or fever in the past 3 months (2·70, 1·35-5·40); and the absence of chickens at home (1·90, 0·93-3·88). After inclusion of microbiological data, a reduced proportion of Fusobacterium (4·63, 1·61-13·35), Capnocytophaga (3·69, 1·48-9·17), Neisseria (3·24, 1·10-9·55), and Spirochaeta in the mouth (7·77, 2·12-28·42), and an increased proportion of Prevotella (2·53, 1·07-5·98), were associated with noma. We identified no specific single bacterial or viral pathogen in cases.InterpretationNoma is associated with indicators of severe poverty and altered oral microbiota. The predominance of specific bacterial commensals is indicative of a modification of the oral microbiota associated with reduced bacterial diversity.FundingGertrude Hirzel Foundation.Copyright © 2013 Baratti-Mayer et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

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