{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:44:23Z","timestamp":1781077463736,"version":"3.54.1"},"reference-count":37,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>In clinical settings, understanding the markers and clinical signs of infection is critical for timely diagnosis and treatment. However, a point-of-care diagnostic test is lacking for noma, a debilitating orofacial infectious disease. This retrospective study reviewed electronic medical records (EMRs) and paper medical records (PMRs) of noma patients from Facing Africa (235 EMRs), Yekatit 12 Hospital (68 PMRs), and Project Harar (33 PMRs) in Ethiopia to identify essential infection markers and clinical presentations of acute noma. The review identified seven acute noma patients aged 4\u20139 years. The patients presented with facial edema, pain, anorexia, ecchymosis, excessive salivation, and drooling, as well as specific symptoms such as visual disturbances, high fever, foul odor, halitosis, and local tenderness. Laboratory findings included elevated white blood cell counts (13,500\u201314,500 cells\/mcL), C-reactive protein levels (107\u2013148 mg\/L), and erythrocyte sedimentation rates (65\u201390 mm\/hour). At &gt;85 ng\/mL, procalcitonin levels were particularly high. Accurate diagnosis of noma requires a comprehensive approach that includes thorough clinical examination, appropriate disease stage classification, medical history review, and laboratory testing. The study highlights the critical infection markers and clinical presentations associated with acute noma that may aid in early diagnosis of the disease. Further research with a much larger number of participants is needed. However, given the difficulty in identifying acute noma cases due to the rapid progression and very high mortality of the disease and the challenge of accessing acute noma cases owing to various socioeconomic barriers, the results of this small study are still relevant.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0520","type":"journal-article","created":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T20:35:14Z","timestamp":1733258114000},"page":"528-532","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Diagnosis of Acute Noma: Essential Infection Markers and Clinical Presentations"],"prefix":"10.4269","volume":"112","author":[{"given":"Heron Gezahegn","family":"Gebretsadik","sequence":"first","affiliation":[{"name":"School of Global Health & Bioethics, Euclid University, Banjul, Gambia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Laryngoscope","first-page":"96","article-title":"Noma surgery","volume":"129","author":"Shaye","year":"2019"},{"key":"b2","series-title":"J Infect Dev Ctries","first-page":"89","article-title":"Noma and noma-like disease in HIV\/AIDS patients, a comorbid interaction: A systematic review","volume":"12","author":"Prado-Calleros","year":"2018"},{"key":"b3","series-title":"Shattered Smiles: The FACES of NOMA","author":"Gebretsadik","year":"2023"},{"key":"b4","series-title":"Oral Health Prev Dent","first-page":"321","article-title":"Necrotising ulcerative gingivitis: A literature review","volume":"15","author":"Dufty","year":"2017"},{"key":"b5","series-title":"Br J Oral Maxillofac Surg","first-page":"51","article-title":"Cancrum oris-like lesions","volume":"29","author":"Nash","year":"1991"},{"key":"b6","series-title":"Crit Rev Oral Biol Med","first-page":"159","article-title":"Oro-facial gangrene (noma\/cancrum oris): Pathogenetic mechanisms","volume":"11","author":"Enwonwu","year":"2000"},{"key":"b7","series-title":"Cureus","first-page":"e63023","article-title":"Acute necrotizing ulcerative gingivitis: A case report","volume":"16","author":"Gollapudi","year":"2024"},{"key":"b8","series-title":"Glob J Health Sci","first-page":"53","article-title":"A review on noma: A recent update","volume":"8","author":"Ashok","year":"2015"},{"key":"b9","series-title":"Lancet Infect Dis","first-page":"e221","article-title":"Prevalence, incidence, and reported global distribution of noma: A systematic literature review","volume":"22","author":"Galli","year":"2022"},{"key":"b10","series-title":"Ann Dermatol Venereol","first-page":"199","article-title":"Noma chez des adultes infect\u00e9s par le VIH [Noma in HIV-infected adults]","volume":"130","author":"Faye","year":"2003"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"1269","article-title":"Lao noma survivors: A case series, 2002\u20132020","volume":"106","author":"Srour","year":"2022"},{"key":"b12","series-title":"Facial Plast Surg","first-page":"439","article-title":"Noma and necrotizing fasciitis of the face and neck","volume":"37","author":"Miller","year":"2021"},{"key":"b13","series-title":"PLoS Negl Trop Dis","first-page":"e0008435","article-title":"Why is noma a neglected-neglected tropical disease?","volume":"14","author":"Srour","year":"2020"},{"key":"b14","series-title":"Oral Dis","first-page":"172","article-title":"The World Health Organization initiative on noma","volume":"5","author":"Bourgeois","year":"1999"},{"key":"b15","series-title":"NOMA Is a Severe Disease It is Treatable If Detected and Managed Early!","year":"2016"},{"key":"b16","series-title":"JAAD Case Rep","first-page":"18","article-title":"Noma: A disease of poverty presenting at an urban hospital in the United States","volume":"1","author":"Maley","year":"2014"},{"key":"b17","series-title":"PLoS Negl Trop Dis","first-page":"e0009437","article-title":"Noma, a neglected disease: A viewpoint article","volume":"15","author":"Farley","year":"2021"},{"key":"b18","series-title":"Bull World Health Organ","first-page":"365","article-title":"Improving prevention, recognition and treatment of noma","volume":"98","author":"Caulfield","year":"2020"},{"key":"b19","series-title":"Trop Doct","first-page":"230","article-title":"An unusual case of noma caused by Klebsiella pnuemoniae and its management","volume":"48","author":"Gupta","year":"2018"},{"key":"b20","series-title":"West Indian Med J","first-page":"33","article-title":"Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy-induced neutropenia","volume":"47","author":"Brady-West","year":"1998"},{"key":"b21","series-title":"Indian J Dermatol Venereol Leprol","first-page":"373","article-title":"Cancrum oris (noma): An early sign of acute lymphoblastic leukemia relapse","volume":"84","author":"Madabhavi","year":"2018"},{"key":"b22","series-title":"Int Health","first-page":"149","article-title":"Noma: Neglected, forgotten and a human rights issue","volume":"7","author":"Srour","year":"2015"},{"key":"b23","series-title":"Trop Med Health","first-page":"40","article-title":"Noma staging: A review","volume":"50","author":"Khammissa","year":"2022"},{"key":"b24","series-title":"Am J Trop Med Hyg","first-page":"909","article-title":"Epidemiology of the incidence of oro-facial noma: A study of cases in Dakar, Senegal, 1981\u20131993","volume":"61","author":"Bourgeois","year":"1999"},{"key":"b25","series-title":"Oral Dis","first-page":"150","article-title":"Microbiological understandings and mysteries of noma (cancrum oris)","volume":"5","author":"Falkler","year":"1999"},{"key":"b26","series-title":"Clin Exp Dermatol","first-page":"372","article-title":"Necrotizing stomatitis in the developed world","volume":"31","author":"Buchanan","year":"2006"},{"key":"b27","series-title":"J All India Dent Assoc","first-page":"183","article-title":"Report of the enquiry \u201cincidence of acute necrotizing ulcerative gingivitis and periodontosis\u201d among cases seen at the Government Hospital","volume":"37","author":"Miglani","year":"1965"},{"key":"b28","series-title":"J Contemp Dent Pract","first-page":"28","article-title":"The epidemiology, etiology, and pathophysiology of acute necrotizing ulcerative gingivitis associated with malnutrition","volume":"5","author":"Folayan","year":"2004"},{"key":"b29","series-title":"Int Health","first-page":"290","article-title":"Noma-knowledge and practice competence among primary healthcare workers: A cross-sectional study in Burkina Faso","volume":"11","author":"Brattstr\u00f6m-Stolt","year":"2019"},{"key":"b30","series-title":"Am J Trop Med Hyg","first-page":"539","article-title":"Noma in Laos: Stigma of severe poverty in rural Asia","volume":"78","author":"Srour","year":"2008"},{"key":"b31","series-title":"Int Health","first-page":"28","article-title":"\u201cI treat it but I don\u2019t know what this disease is\u201d: A qualitative study on noma (cancrum oris) and traditional healing in northwest Nigeria","volume":"12","author":"Farley","year":"2020"},{"key":"b32","series-title":"Lancet Child Adolesc Health","first-page":"685","article-title":"Noma: A neglected oro-facial childhood disease","volume":"5","author":"Khammissa","year":"2021"},{"key":"b33","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"111845","article-title":"Noma is a facial disfiguring childhood disease: Insights from cases of noma in Ethiopia","volume":"177","author":"Gebretsadik","year":"2024"},{"key":"b34","series-title":"J Orthop Sports Med","first-page":"226","article-title":"Impact of erroneous belief on timely health care-seeking practices among noma (facial gangrene) survivors in Ethiopia","volume":"5","author":"Gebretsadik","year":"2023"},{"key":"b35","series-title":"Am J Trop Med Hyg","first-page":"535","article-title":"Missing the forest for the trees in biomedical research: The example of noma","volume":"78","author":"Vinetz","year":"2008"},{"key":"b36","series-title":"Noma","year":"2023"},{"key":"b37","series-title":"Korean J Intern Med","first-page":"285","article-title":"Procalcitonin as a biomarker of infectious diseases","volume":"28","author":"Lee","year":"2013"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/3\/article-p528.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/3\/article-p528.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/3\/article-p528.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T14:31:20Z","timestamp":1741185080000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/3\/article-p528.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":37,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0520","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]}}}