Noma — DTM&H MCQ

Correct answer: D — Noma (cancrum oris)

The correct answer is D, Noma (cancrum oris). This is a rapidly progressive, necrotising orofacial gangrene that occurs in severely malnourished children in resource poor settings, classically following an immunosuppressive illness such as measles, and West Africa is one of the leading noma-endemic regions. The stem's combination of a recent measles infection, severe malnutrition, and rapid tissue necrosis exposing the maxillary bone is the textbook presentation: the disease begins as a gingival ulcer (a fusospirochaetal infection) and spreads through the soft tissue and bone within days, causing disfiguring facial destruction. Mortality without urgent nutritional and antimicrobial treatment approaches 90 percent, and the World Health Organization formally recognised noma as a neglected tropical disease in December 2023, reflecting exactly this epidemiological picture. Why the other options are wrong: E. Burkitt lymphoma: presents as a slower growing jaw or facial mass (often maxillary) in African children linked to EBV and malaria, not as an acute necrotising gangrenous ulcer following measles and malnutrition. A. Cervicofacial actinomycosis: causes a chronic, indurated woody swelling with sinus tracts discharging sulphur granules, typically after dental infection or trauma, not an acute necrotic process in a malnourished child. B. Ludwig angina: is a bilateral submandibular and sublingual space cellulitis causing airway compromise, usually from a dental source in adults; it does not cause bone-exposing facial gangrene or arise from measles or malnutrition. C. Oral Kaposi sarcoma: produces vascular, purplish nodular or plaque lesions associated with HIV and HHV-8, evolving over weeks to months, not an acute destructive necrotic process. Key point: rapid orofacial gangrene with bone exposure in a malnourished child recovering from measles is pathognomonic for noma (cancrum oris).

Reference: World Health Organization, Noma fact sheet and NTD listing (December 2023): https://www.who.int/news-room/fact-sheets/detail/noma