Noma — DTM&H MCQ

Correct answer: C — Noma

Noma (C) is the correct answer because it is a rapidly progressive orofacial gangrene that classically begins as acute necrotising gingivitis and then spreads through the soft and hard tissues of the cheek within days, almost exclusively in severely malnourished children living in conditions of extreme poverty, poor oral hygiene and recent illness (such as measles or malaria) that compromise immunity. The stem's combination of severe malnutrition, a conflict setting, antecedent gingivitis and rapid facial necrosis is the textbook description of noma, which the WHO now formally recognises as a neglected tropical disease. Pathogenesis is polymicrobial (fusospirochaetal organisms such as Fusobacterium necrotans and spirochaetes acting synergistically with anaerobes) rather than a single pathogen, which is why it is treated with broad-spectrum antibiotics, aggressive nutritional rehydration and rehabilitation, and debridement once demarcated. Why the other options are wrong: B. Buruli ulcer: caused by Mycobacterium ulcerans, produces a painless skin nodule or ulcer typically on limbs, not preceded by gingivitis and not linked to acute malnutrition or oral disease progression. D. Cutaneous diphtheria: caused by toxigenic Corynebacterium diphtheriae, produces a punched-out ulcer with a grey membrane usually following skin trauma, not arising from gingivitis or progressing through facial tissue this rapidly. E. Cancrum oris due to leishmaniasis: cancrum oris is simply another name for noma itself and is not caused by Leishmania; this option incorrectly attributes the aetiology, so it is a distractor combining a correct synonym with a wrong cause. A. Mucormycosis: an angioinvasive fungal infection typically seen in diabetic ketoacidosis or immunosuppressed/neutropenic patients, not specifically linked to childhood malnutrition or preceding gingivitis, and progresses via vascular invasion rather than gingival spread. Key point: Noma is the diagnosis to suspect when acute necrotising gingivitis in a severely malnourished child rapidly progresses to orofacial gangrene.

Reference: World Health Organization, Noma fact sheet, 2023 (who.int/news-room/fact-sheets/detail/noma); noma officially recognised as a neglected tropical disease, December 2023