Fresh
noma is a severe orofacial
necrosis with an astonishingly rapid development. It is seen mainly in malnourished children less than 4 years old from developing countries.
Cytokines play a central role in oral mucosal
inflammation. We therefore studied the relevance of circulating
cytokines to
noma, and the key microorganisms associated with the lesion. Nigerian village children with acute
noma (n=68) and their neighborhood village (n=63) as well as urban (n=45) counterparts of comparable age and free of overt
infections were evaluated for serum
cytokine levels by ELISA. Oral bacteria were studied by polymerase chain reaction. Evaluation of random cases of the village and
noma children showed marked depletion (p<0.05 or 0.001) of the plasma
antioxidant micronutrients (
retinol,
ascorbic acid,
zinc) as well as
albumin and blood
hemoglobin in the latter, relative to the former group. Concentrations of the circulating, pro-inflammatory
cytokines (IL-18, IL-6, IL-12, IL-8, IFN-gamma) and the soluble inhibitors (TNFR-p55, TNFR-p75 and IL-1ra) were significantly higher (p<0.01 or 0.001) in
noma children than in the healthy urban children, but less so when compared to their neighborhood village counterparts. The increase in levels of the anti-inflammatory/regulatory
cytokines (IL-4, IL-10 and TGF-beta) was less marked relative to the pro-inflammatory
cytokines. Bacteria observed at the highest frequencies in
noma lesions were P. intermedia (83%), T. forsythensis (83%), P. gingivalis (50%), C. rectus (50%) and T. denticola (50%). We conclude that
noma is an immunopathological response to potent bacterial factors resulting in uncontrolled production of
cytokines and possibly other, still unknown, inflammatory mediators.