my cancrum oris

8/3/2019 My Cancrum Oris

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CANCRUM

ORISSOYEBO OLUSEYE alegra


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OUTLINE

} INTRODUCTION

} EPIDEMIOLOGY}ORGANISMS

} PREDISPOSING FACTORS

} PATHOGENESIS

}MANAGEMENT}CONCLUSION


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INTRODUCTION

} a.k.a NOMA &GANGRENOUS STOMATITIS

} Is a devastating disease characterized bythe destructive process of the oro-facialtissues.

} is a rapidly progressive, polymicrobial,

opportunistic infection that occurs duringperiods of compromisedimmunefunction.


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EPIDEMIOLOGY

} In Sub Saharan Africa, it is seen in

children 3-10 years.

} In Nigeria, prevalence among children is23%

}AIDS related NOMA prevalence 4.3-16.0%


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ORGANISMS

} Fusobacterium necrophorum

} Borrelia vincenttii} Staphylococcus aureus

} Prevotella intermedia


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PREDISPOSING FACTORS

} Severe malnutrition

} Poverty} Immunosuppression

} Poor oral and general hygiene

} Infectious diseases e.g. measles, chicken

pox, T.B etc.} smoking


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PATHOGENESIS

}Noma starts within the oral cavity progressing fromuntreated Acute Necrotizing Ulcerating Gingivitis(ANUG): - halitosis, bleeding gum,painful gumand

pseudomembranousulcers.

} The Bacteroides produce a range of destructivemetabolites such as collagenase, fibrinolysin,endotoxins, hydrogen sulfide, Indole ammonia fatty

acids, protease.

} The ulcers are covered with whitish- yellow or brown

fibrin and debris.


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} The gangrenous necrosis progressively involves the

buccae, the lips, and the adjacent bone,producing catastrophic lesions on the face.

} CLINICAL FEATURES

} Salivation, halitosis, fever, malaise, and regional

lymphadenopathy.} Facial edema

} cheek, chin, infraorbital margin, palate, nose,antrum or any part of the face may be affected

}Marked fetid oral odor = H2S, Indole, Ammonia


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DIAGNOSTIC PATOLOGY} Fusiform Necrophorum is a cigar shaped

organism Gram positive 5-12micron inlength with a straight or slightly curvedaxis. Easily decolorized on Gram stain

and is non motile.

}Cultured anaerobically on serum agar orserum broth

} The culture is pleomorphic and the

organism has little effect on laboratoryanimals.


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} Borelli Vincentia measures 5-10micron in

length} Has 3-8 irregular spirals

} It is actively motile

}Gram negative and stains poorly

} It can be demonstrated in fresh materialby dark ground examination

}Cultured anaerobically on serum agar orserum broth

}No effect on guinea pig


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} Inoculation of both organism though

produces infection

} In summary, these organisms can bedemonstrated on smears from ulceratedlesion s by gram stain , dark ground

examination is also useful}Culture and animal inoculate are further

diagnostic procedures.


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PREVENTION} Will require measures that address these

problems, and also importantly, eliminate

fecal contamination of foods and water

supplies.

} Adequate diet for young children (weaning)

} Brushing the teeth, keeping the mouth cleanto prevent development of gum ulcers, NUG

that leads to Noma.

}

Parental education} Training health care workers to recognize the

early symptoms and give emergency care


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MANAGEMENT

} Begins with proper history which reveals age,

habit and socioeconomic level among others

} Proper examination will reveal symptoms of

malnutrition via fluffy hair, thinned out musclesetc.

} Local examination will reveal a grotesque

ulcer whose base may be larger than theapex depending on the stage of presentation

} Proper investigation will either implicate or rule

out underlying etiological factor


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} Treatment is broadly classified into immediate and

long term} In the immediate pain is controlled and the

underlying causative factors are treated

} Patients do well with combination of penicillin,

aminoglycoside and metronidazole.} Local infection is controlled by wound debridement

and dressing.

}After full recovery of health, reconstruction surgery isrequired to prevent permanent mutilation.


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CONCLUSION

} The management of Cancrum Oris is suchan herculean task that the best method

of management is preventive

} This is the strategy WHO has put in placemaking the disease almost an historyespecially in previously endemic area


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