• Wednesday July 15,2020

Noma (Water Cancer)

Noma, also called water cancer or cheek blight, is a serious infectious disease of the cheek mucosa, which originates from bacteria of the oral mucosa and untreated extends to the surrounding soft and bone tissue. Noma primarily affects children in developing countries because of environmental factors such as malnutrition, poor hygiene and inadequately treated infectious diseases that favor the development of a noma.

What is noma?

Noma is a severe form of progressive (progressive) buccal inflammation caused by bacterial infection by Borrelia and Fusobacteria.

Noma manifests itself in insufficient hygienic conditions and a generally poor health of the person affected, which is why the disease usually occurs in children with impaired immune defense due to infectious diseases or malnutrition in developing countries.

Noma is initially associated with ulcers of the oral mucosa, which spread as the disease progresses, decomposing the body's own tissues, damaging the facial bones and thus characteristic of noma symptoms such as foul-smelling bad breath, necrotic areas in the face and mucous membranes, pain and fever cause.

In addition, as a result of the increasing size of necrotic areas in the advanced stage, noma causes an impairment of the sense organs and the speech apparatus.


Noma is caused by normally harmless bacteria (Borrelia, Fusobacteria) that are typically found in the human mouth. If the immune defense is weakened by poor hygienic conditions, infectious diseases such as measles, scarlet fever, rubella or meningitis and by malnutrition (especially lack of proteins, vitamins, electrolytes), the bacteria, especially in children of up to six years, in the oral mucosa multiply from where they spread to the surrounding tissue (skin, mucosa and facial bones) and trigger noma.

Symptoms, complaints & signs

Noma (water cancer) is a serious disease of malnourished children in developing countries that, if left untreated, leads to death or disfigurement despite treatment. The disease starts with a small wound in the oral mucosa and leads to large-scale death of tissue and bone parts on the face.

Malnutrition weakens the immune system of children. Add to this the catastrophic hygienic conditions in these countries. This can lead to this catastrophic infection with often otherwise quite harmless bacteria. The disease often starts with bleeding gums and foul bad breath.

On a small wound in the oral mucosa, a red-bluish nodule forms, which quickly spreads to the cheeks and lips. It causes swelling at the inflamed areas, whereby the affected area becomes hard and thick. Furthermore, pus increasingly forms with an increasingly unbearable odor. Patients also suffer from severe pain and fever.

At the site of the swelling, tissue necrosis occurs at a later stage. The dead tissue turns black. This area is surrounded by a white line, which indicates as a boundary line the further progression of tissue degradation. The general condition worsens drastically and is accompanied by diarrhea and fever. In the final stage of the disease, it can destroy almost all parts of the face. Death occurs in untreated individuals from pneumonia, septicemia or bloody diarrhea.

Diagnosis & History

Noma is usually diagnosed on the basis of the characteristic symptoms and associated circumstances, such as a weakened immune system as a result of a previous infectious disease or malnutrition, as well as inadequate hygienic conditions.

The symptoms typical of Noma are ulcers in the oral mucosa, which cause foul-smelling bad breath and spread successively to the soft and bone parts of the face and thus permanently affect the sensory organs and the vocal tract.

In the advanced stage, parts of the facial bones can be exposed and sepsis (blood poisoning) or pneumonia (aspiration pneumonia) can reach life-threatening proportions. In developing countries, Noma is often severe in many cases, as there are often inadequate therapies available in these areas.

Approximately 90 percent of children affected by noma die in these areas, although the prognosis for early onset of therapy is good. In contrast, the survivors have severe facial disfigurement due to noma disease.


Noma (water cancer) always leads to deadly complications if left untreated. In the early stages of the disease there are still very good chances of recovery. However, if at the beginning of the disease there is no change in diet with sufficient supply of proteins and vitamins, the number of bacteria in the mouth area increases so much that it decomposes the local tissue.

The end state is characterized by fatal sepsis, further tissue breakdown in the mouth area, pneumonia or severe bloody diarrhea. Over 90 percent of children affected by Noma do not survive the disease. Even after a medical treatment can still have long-term consequences and complications. These episodes include a severely scarred face.

Sometimes even the tissues of the lips, cheeks or eye sockets completely decompose. The face is then distorted forever. The consequences of the disfigurement are particularly bad for those affected, because the scars and mutilations often lead to lifelong burdens and disabilities of humans. Those affected most then suffer from mental health problems.

They are often discriminated against because of their disfigurement and thus get into loneliness and social isolation. In the affected families, the sick children are often rejected, making them completely neglected. They do not show themselves publicly, but live hidden. So they are excluded from normal development.

When should you go to the doctor?

If mouth and mouth infections, ulcers and other signs of serious illness occur, a doctor should be consulted. The physician can diagnose noma and contribute to a speedy recovery through rapid treatment. Therefore, first symptoms should already be clarified. Those living in poor hygiene conditions or suffering from malnutrition are particularly susceptible to infection. HIV, AIDS and typhoid patients as well as people with a disease of the immune system are among the risk groups and should go to the family doctor with these complaints.

If symptoms occur after staying in one of the countries at risk, seek medical attention immediately. The same applies to advanced diseases, which may have already spread to the internal organs. So must go to the nearest hospital with skin bleeding, coughing blood and severe gastrointestinal discomfort promptly. In addition to the family doctor, an internist or dermatologist may be involved in the treatment of noma. Children should be promptly referred to the pediatrician for signs of noma infection.

Treatment & Therapy

Therapeutic measures at Noma are conditioned by the stage of the disease and focus on controlling and eliminating the infection, preventing relapses (recurrence of the disease), and treating concomitant symptoms. Thus, in the early stage (stage I) of a disease with noma therapeutic measures aimed at eliminating malnutrition, especially by an additional supply of proteins, vitamins and electrolytes, and a narrowing of the infection by antiseptic mouthwashes with chlorhexidine and metronidazole.

In the second stage of disease, a swab is taken from the affected area to determine the specific bacterial strain and the antibiotic mix to be used for the treatment, while mouth rinses are still used. Later in the noma (stage III), in addition to the antibiotic therapy, an artificial diet to compensate for the lack of fluid and electrolyte is required.

If the noma continues to progress, so that there is already a replacement of the necrotic (dead) tissue (stage IV), a plastic reconstruction to restore the damaged parts of the face in the context of surgery is indicated. Such operations are often out of reach in developing countries, and affected children have life-long facial scars and disfigurements, which requires additional psychological care for children affected by Noma.

Outlook & Forecast

The prognosis of Noma is unfavorable. Without a comprehensive medical care threatens the affected premature death. The risk group of the disease includes children with malnutrition, most of whom live in developing countries. If physicians are able to save the child's survival with a drug therapy and special mouth rinses, long-term damage is almost inevitable.

The more advanced the disease, the more difficult the outlook becomes. The children undergo visual changes and adjustments in the area of ​​the face. Despite all efforts and early therapy, these can not yet be ruled out for being outside the care of developing countries. If it is possible to bring the patient to Western regions, cosmetic surgery can bring about a reduction in visual abnormalities. The procedures are associated with a high cost and the possibility of complications. Therefore, they are only very few sufferers.

Due to the discomfort and visual peculiarities the person concerned is threatened with emotional and emotional conflicts. Conditions of stress can lead to mental sequelae. These have a further negative influence on the quality of life and the general well-being of the person concerned. With a very favorable course of the disease not only the survival of the child can be secured, but there is also the prospect that exclusive scars remain on the face.


Noma can be prevented by adequate sanitary measures and comprehensive medical care. Accordingly, the disease in developing countries could be avoided by improving the living conditions and quality of children. In particular, a minimization of malnutrition, an improvement in the hygienic conditions as well as an early and comprehensive medical treatment of infectious diseases and appropriate vaccinations can contribute to a lower incidence of noma in developing countries.


The disease water cancer actually requires a minor medical therapy. However, this is not available in the distribution areas. The same applies to medical follow-up. Therefore, two groups have to be distinguished: those who die and the others who survive. The former include up to 90 percent of patients.

The survivors of the cheek burn need a follow-up, but do not receive it due to the desolate medical care system. For them, only a life with disfigurements and disadvantages remains. The water cancer leads to European standards for a long-term treatment in which the patient receives any support.

In particular, the mutilated and disfigured face requires medical attention. It can be restored via plastic reconstructions. This requires several interventions and numerous ideas at the doctor. Until a satisfactory result, routine checks take place. In addition to physical examinations, blood analyzes are also initiated.

The disease Noma may recur. A close follow-up tries to prevent this in the distribution areas. Doctors fight against malnutrition, administer the missing vaccines and teach basic hygiene standards. Compliance with the last is the responsibility of the patient or his parents.

You can do that yourself

In order to be able to treat noma (water cancer) well, the general condition of the patients - mostly children in developing countries - must stabilize. These include regular meals with increased protein, vitamins and electrolytes as well as plenty of drinking, sufficient rest and protection from sunlight and / or insects.

In doing so, the patient's immune system needs to be built up to cope with the borrelia and bacteria that caused the disease. The hygiene in the environment is also extremely important. It must be possible for the patient to wash daily and also to clean and care for the affected areas. In the beginning, antiseptic mouth rinses are sufficient, but if the disease is already advanced, antibiotics must also be taken. The prescribed medication should be taken regularly and should not be stopped early.

If the infection is overcome, scarring can disfigure the face. Depending on the culture, corrective surgery is not always possible. Nevertheless, opportunities must be found for the patients to cope with their sometimes significant distortions. The best are psychotherapeutic accompanying treatments or other assistance, as they offer various aid organizations on the ground (see also www.nonoma.org/).

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