Journal article
Risk factors for noma disease: a 6-year, prospective, matched case-control study in Niger.
- Baratti-Mayer D GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
- Gayet-Ageron A GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Clinical Epidemiology, Department of Community Health and Medicine, University of Geneva Hospitals, Geneva, Switzerland; Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland.
- Hugonnet S Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland; Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, Switzerland.
- François P Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland.
- Pittet-Cuenod B GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
- Huyghe A Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland; University of Geneva, Sciences III, Department of Plant Biology, Microbiology Unit, Geneva, Switzerland.
- Bornand JE GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Central Laboratory of Virology, University of Geneva Hospitals, Geneva, Switzerland.
- Gervaix A GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Department of Paediatrics, University of Geneva Hospitals, Geneva, Switzerland.
- Montandon D GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland.
- Schrenzel J GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Genomic Research Laboratory and Clinical Microbiology Laboratory, University of Geneva Hospitals, Geneva, Switzerland.
- Mombelli A GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Department of Periodontology and Oral Pathophysiology, School of Dental Medicine, University of Geneva Faculty of Medicine, Geneva, Switzerland.
- Pittet D GESNOMA, Division of Plastic and Reconstructive Surgery, University of Geneva Hospitals, Geneva, Switzerland; Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland. Electronic address: didier.pittet@hcuge.ch.
- 2014-08-09
Published in:
- The Lancet. Global health. - 2013
Birth Order
Capnocytophaga
Case-Control Studies
Child
Child, Preschool
Diarrhea
Family Characteristics
Female
Fever
Fusobacterium
Growth Disorders
Humans
Infant
Male
Microbiota
Mouth
Neisseria
Niger
Noma
Poverty
Prevotella
Prospective Studies
RNA, Ribosomal, 16S
Respiratory Tract Diseases
Risk Factors
Spirochaeta
Vitamin A
Wasting Syndrome
alpha-Tocopherol
English
BACKGROUND
Noma is a poorly studied disease that leads to severe facial tissue destruction in children in developing countries, but the cause remains unknown. We aimed to identify the epidemiological and microbiological risk factors associated with noma disease.
METHODS
We did a prospective, matched, case-control study in Niger between Aug 1, 2001, and Oct 31, 2006, in children younger than 12 years to assess risk factors for acute noma. All acute noma cases were included and four controls for each case were matched by age and home village. Epidemiological and clinical data were obtained at study inclusion. We undertook matched-paired analyses with conditional logistic regression models.
FINDINGS
We included 82 cases and 327 controls. Independent risk factors associated with noma were: severe stunting (odds ratio [OR] 4·87, 95% CI 2·35-10·09) or wasting (2·45, 1·25-4·83); a high number of previous pregnancies in the mother (1·16, 1·04-1·31); the presence of respiratory disease, diarrhoea, or fever in the past 3 months (2·70, 1·35-5·40); and the absence of chickens at home (1·90, 0·93-3·88). After inclusion of microbiological data, a reduced proportion of Fusobacterium (4·63, 1·61-13·35), Capnocytophaga (3·69, 1·48-9·17), Neisseria (3·24, 1·10-9·55), and Spirochaeta in the mouth (7·77, 2·12-28·42), and an increased proportion of Prevotella (2·53, 1·07-5·98), were associated with noma. We identified no specific single bacterial or viral pathogen in cases.
INTERPRETATION
Noma is associated with indicators of severe poverty and altered oral microbiota. The predominance of specific bacterial commensals is indicative of a modification of the oral microbiota associated with reduced bacterial diversity.
FUNDING
Gertrude Hirzel Foundation.
Noma is a poorly studied disease that leads to severe facial tissue destruction in children in developing countries, but the cause remains unknown. We aimed to identify the epidemiological and microbiological risk factors associated with noma disease.
METHODS
We did a prospective, matched, case-control study in Niger between Aug 1, 2001, and Oct 31, 2006, in children younger than 12 years to assess risk factors for acute noma. All acute noma cases were included and four controls for each case were matched by age and home village. Epidemiological and clinical data were obtained at study inclusion. We undertook matched-paired analyses with conditional logistic regression models.
FINDINGS
We included 82 cases and 327 controls. Independent risk factors associated with noma were: severe stunting (odds ratio [OR] 4·87, 95% CI 2·35-10·09) or wasting (2·45, 1·25-4·83); a high number of previous pregnancies in the mother (1·16, 1·04-1·31); the presence of respiratory disease, diarrhoea, or fever in the past 3 months (2·70, 1·35-5·40); and the absence of chickens at home (1·90, 0·93-3·88). After inclusion of microbiological data, a reduced proportion of Fusobacterium (4·63, 1·61-13·35), Capnocytophaga (3·69, 1·48-9·17), Neisseria (3·24, 1·10-9·55), and Spirochaeta in the mouth (7·77, 2·12-28·42), and an increased proportion of Prevotella (2·53, 1·07-5·98), were associated with noma. We identified no specific single bacterial or viral pathogen in cases.
INTERPRETATION
Noma is associated with indicators of severe poverty and altered oral microbiota. The predominance of specific bacterial commensals is indicative of a modification of the oral microbiota associated with reduced bacterial diversity.
FUNDING
Gertrude Hirzel Foundation.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1016/S2214-109X(13)70015-9
- PMID 25104163
- Persistent URL
- https://sonar.ch/global/documents/38917
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