Cancrum Oris among children seen at Paediatric Medical Ward Ahmadu of Bello University Teaching Hospital, Zaria: A Case series

Abstract

Background: Cancrum oris (Noma) is an opportunistic infection promoted by extreme poverty. It evolves rapidly
from a gingival inflammation to grotesque orofacial gangrene. It occurs worldwide but is most common in SubSaharan Africa. The peak incidence of this gangrenous stomatitis is at age 1-4 years coinciding with the period of
linear growth retardation in deprived children. Noma is a scourge in communities with poor environmental sanitation
that results from complex interactions between malnutrition, infections, and compromised immunity. Diseases that
commonly preceded Noma include measles, malaria, severe diarrhoea, and necrotizing ulcerative gingivitis. The
acute stage responds readily to antibiotic treatment. The sequelae after healing include variable functional and
aesthetic impairments that require reconstructive surgery. Noma can be prevented through the promotion of national
awareness of the disease, poverty reduction, improved nutrition, promotion of exclusive breastfeeding, optimal
prenatal care, and timely immunization against the common childhood diseases. Case Series: Four children aged
between 2 and 13 years were admitted and managed for Cancrum oris within 3 months (June –August 2022). Two of
the patients had measles and one had both measles and varicella infections. One of them received only the BCG
vaccine while the remaining 3 did not receive any form of vaccination. All of them were undernourished and from low
socioeconomic backgrounds. They all responded to medical treatment and were subsequently referred for
reconstructive surgery. The cases are presented to create awareness.