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The dehumanizing oro-facial gangrenous lesion affects predominantly children ages 2 to 16 years, particularly in sub-Saharan Africa, where the estimated frequency in some communities varies from I to 7 cases per 1000 population. The risk factors are poverty, malnutrition, poor oral hygiene, residential proximity to livestock in unsanitary environments, and infectious diseases, particularly measles and those due to the herpesviridae. Infections and malnutrition impair the immune system, and this is the common denominator for the occurrence of noma. Acute necrotizing gingivitis (ANG) and oral herpetic ulcers are considered the antecedent lesions, and ongoing studies suggest that the rapid progression of these precursor lesions to noma requires infection by a consortium of micro-organisms, with F usobacterium necrophorum (Fn) and P revotella intermedia (Pi) as the suspected key players. Additional to production of a growth-stimulating factor for Pi, Fn displays a classic endotoxin, a dermonecrotic toxin, a cytoplasmic toxin, and a hemolysin. Without appropriate treatment, the mortality rate from noma is 70-90%. Survivors suffer the two-fold afflictions of oro-facial mutilation and functional impairment, which require a time-consuming, financially prohibitive surgical reconstruction. <\/jats:p>","DOI":"10.1177\/10454411000110020201","type":"journal-article","created":{"date-parts":[[2009,1,9]],"date-time":"2009-01-09T00:40:32Z","timestamp":1231461632000},"page":"159-171","source":"Crossref","is-referenced-by-count":117,"title":["Oro-Facial Gangrene (Noma\/Cancrum Oris): Pathogenetic Mechanisms"],"prefix":"10.1177","volume":"11","author":[{"given":"C.O.","family":"Enwonwu","sequence":"first","affiliation":[{"name":"Department of OCBS, University of Maryland, 666 W. Baltimore Street, Room 4-G-31, Baltimore, Maryland 21201-1586, USA, Department of Biochemistry, University of Maryland, 666 W. Baltimore Street, Room 4-G-31, Baltimore, Maryland 21201-1586, USA, School of Medicine, University of Maryland, 666 W. Baltimore Street, Room 4-G-31, Baltimore, Maryland 21201-1586, USA, , School of Dentistry"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"W.A.","family":"Falkler","sequence":"additional","affiliation":[{"name":"Microbiology and Immunology, School of Dentistry, University of Maryland, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.O.","family":"Idigbe","sequence":"additional","affiliation":[{"name":"Nigerian Institute for Medical Research, Yaba, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2000,4,1]]},"reference":[{"key":"atypb1","doi-asserted-by":"crossref","unstructured":"Adekeye EO, Ord RA (1983). 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