03515nas a2200625   4500000000100000008004100001653002100042653001400063653001600077653002400093653001700117653003100134653002400165653001500189653001200204653000900216653001000225653001400235653001000249653001500259653000900274653001100283653001100294653002100305653001800326653001000344653001100354653002700365653001300392653002100405653001000426653002500436653001900461653001600480653002100496100002000517700001900537700001500556700001600571700002000587700001300607700001400620700001400634700001600648700001600664700001500680700001300695700004200708245009500750856007900845300001100924490000600935520193400941022001402875       2013                            d10aWasting Syndrome10aVitamin A10aSpirochaeta10aRNA, Ribosomal, 16S10aRisk Factors10aRespiratory Tract Diseases10aProspective Studies10aPrevotella10aPoverty10aNoma10aNiger10aNeisseria10aMouth10aMicrobiota10aMale10aInfant10aHumans10aGrowth Disorders10aFusobacterium10aFever10aFemale10aFamily Characteristics10aDiarrhea10aChild, Preschool10aChild10aCase-Control Studies10aCapnocytophaga10aBirth Order10aalpha-Tocopherol1 aBaratti-Mayer D1 aGayet-Ageron A1 aHugonnet S1 aFrançois P1 aPittet-Cuenod B1 aHuyghe A1 aBornand J1 aGervaix A1 aMontandon D1 aSchrenzel J1 aMombelli A1 aPittet D1 aGeneva Study Group on Noma (GESNOMA) 00aRisk factors for noma disease: a 6-year, prospective, matched case-control study in Niger.  uhttp://www.thelancet.com/pdfs/journals/langlo/PIIS2214-109X(13)70015-9.pdf  ae87-960 v13 a<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>METHODS: </strong>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.</p>

<p><strong>FINDINGS: </strong>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.</p>

<p><strong>INTERPRETATION: </strong>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.</p>

<p><strong>FUNDING: </strong>Gertrude Hirzel Foundation.</p>
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