Noma

Abstract

In their Seminar on noma,1Enwonwu CO Falkler Jr, WA Reshma PS Noma (cancrum oris).Lancet. 2006; 368: 147-156Summary Full Text Full Text PDF PubMed Scopus (134) Google Scholar Cyril Enwonwu and colleagues mention the global burden of the disease, but missed a sporadic case from eastern Turkey.2Yuca K Yuca SA Cankaya H Caksen H Calka O Kiris M Report of an infant with noma (cancrum oris).J Dermatol. 2004; 31: 488-491Crossref PubMed Scopus (10) Google Scholar Further, our group saw another case of noma in an HIV-negative patient with acute lymphoblastic leukaemia during an episode of afebrile neutropenia.3Tacyildiz N, Yavuz G, Unal E, et al. Noma: a rare complication in a febrile neutropenic patient (case report). 4th Febrile Neuropenia Symposium; February 2001; Antalya, Turkey.Google Scholar The history of noma in Turkish paediatrics is also worth noting. Albert Eckstein, who fled from the Nazis to Turkey in 1935, worked in Anatolia between 1935 and 1950, and focused on the epidemiology and treatment of noma.4Eckstein A Weitere Beobachtungen über Noma.Annales Paedatrici. 1944; 162: 89-90Google Scholar, 5Eckstein A Pediatric diseases and prevention in Turkey. Ankara University Medical School, Ankara1947Google Scholar He reported that noma was not a rare disease in Turkey and was mostly seen in the villages. In the rare cases seen in the cities, he observed that patients' living conditions were very poor. Eckstein noted clusters of noma cases in some villages and, rarely, in some families. Although noma was seen in all age-groups, half the cases were in children younger than 4 years. Decreased immune function was a precondition for noma, although causes could be very different, depending on the location. In western Europe, based almost always on very few observations, measles occupied first place. On the other hand, in Eckstein's experience of about 300 cases, malaria was most common. Other diseases such as typhoid, typhus, whooping cough, measles, kala azar, leukaemia, and sarcoma also prepared the ground for noma by decreasing immunity.4Eckstein A Weitere Beobachtungen über Noma.Annales Paedatrici. 1944; 162: 89-90Google Scholar, 5Eckstein A Pediatric diseases and prevention in Turkey. Ankara University Medical School, Ankara1947Google Scholar Eckstein's work revealed that, with not too much effort, the situation around the world could be changed. I declare that I have no conflict of interest.