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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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SINGLE, AVAILABLE AND SEARCHING
08035389894
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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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