A Review of Fusobacterium necrophorum Infections in Humans.

The incidence of human infections caused by Fusobacterium necrophorum is recently on the increase and this is attributed largely to alteration in antibiotic usage pattern, malnutrition and poor oral hygiene. These infections are usually acquired exogenously from animals such as dogs, livestock or humans and ranges from mild sore throat to severe infections like Lemierre’s syndrome and Cancrum oris (NOMA). Fusobacterium necrophorum species produce characteristic toxins and virulent factors which are responsible for the severity of infections. Confirming the presence of these species is recommended during suspected infections. It would help in providing information on the antimicrobial sensitivity pattern so as to guide treatment and control of these severe infections as well as for epidemiological purposes. This review summarizes human infections associated with F. necrophorum providing information on their epidemiology, risk factors, pathogenicity, diagnosis and treatment.

Reconstruction of the Acquired Facial Deformity due to Cancrum Oris Sequelae

Acquired facial deformities following cancrum oris sequelae manifested variably according to the nature of tissue necrosis. In cases that tissue loss extends over a wide area of the face, or the tissue nature is different due to congenital facial cleft, it is difficult to reconstruct with a single operation. As cancrum oris has virtually disappeared from our country, clinical report of reconstruction is also rare. We report 5 cases of facial deformities following cancrum oris sequelae. Since 1988, five adult patients(4 female and 1 male) were treated by authors. These patients, with an age ranged from 47 to 58 years, all suffered from acquired facial cleft such as facial mutilation, asymmetry. The stages of operation were from 1 to maximum of 5 operations. All surgeries achieved satisfactory results after a long-term follow-up. But one surgery in the case of palatal mucosal flap for the coverage of reconstructed maxilla alveolar bone resulted tissue sloughness, followed by osteomyelitis. Those were debrided and discarded. In conclusion, all sites of deformities were positioned around one of the oral commissures. In their past medical history, they have been suffering from measles, typhoid fever and unknown febrile illness. We diagnosed the acquired facial deformity following cancrum oris sequelae. The reconstruction of acquired facial deformity following cancrum oris sequelae were difficult due to extensive multiple tissue defects. Therefore multiple staged operations were inevitable. The authors reconstructed 5 cases of simple and complex form of facial deformity with minimum staged\ operations. All patients were satisfied functionally and cosmetically.

Cancrum oris: observations on its incidence and treatment

1. Fifteen cases of cancrum oris admitted and treated in the Pediatrics Department of the Philippine General Hospital from April 4, 1945 to April 5, 1946 were presented2. The incidence of noma in the Philippines, before, during and after the second world war was discussed3. A reduction of the mortality rate from 70%-100% to 6.67% with the use of sulfa drugs and pencillin was reported4. Other reports on the incidence, mortality, and treatment of cancrum oris were briefly reviewed and compared with our findings. (Conclusions)

Noma in the Philippines

Noma, or stomatitis gangrenosa, cancrum oris, is not yet rare in the Philippines, as it has become in America and Europe. Forty-two cases of noma are describedNoma is a secondary disease due to bad general condition brought about by diseases such as ileocolitis, measles, tuberculosis, sometimes pertussis and bronchopneumoniaThe mortality of noma is excessively high. It is probable that noma occurs in connection with deficiency diseasesIt is a disease of the preschool age in the PhilippinesThe treatment must be a treatment of the primary diseaseImprovement of nutrition and public welfare will put an end to the disease in the near future.(Summary)

On malnutrition in childhood in the Philippines III. pathological findings in malnutrition in the Philippines

The histologic changes in different organs of 32 Filipino infants who died in a state of severe malnutrition were studied. Changes in the intestines, liver and pancreas which have already been described were confirmed. A significant finding was that hemorrhage had occurred in some organs in a total of 29 (91%) of the cases. The frequency distribution of hemorrhages in various organs is as follows: adrenals (medulla) - 26 (81%); bone marrow - 16 (50%); kidneys - 13 (41%); lungs - 13 (41%); liver - 7 (22%); pituitary gland - 5 (16%); heart muscle, thymus, and lymph nodes - 2 cases each (6%); and testes - 1 (3%). The brain was not studied in most of these casesThese findings are interpreted to indicate a general hemorrhagic tendency among cases of severe malnutrition in Filipino infants; furthermore, massive hemorrhages in the adrenal medulla is apparently the cause of death in a high percentage of these cases. The underlying mechanism of this hemorrhagic tendency has yet to be clarifiedHyperemia found in different organs suggests impairment of cardiac function which cannot be detected by electrocardiography as the entire heart muscle seems to be involved. Histologically evident infections seem to play only a minor role in malnutrition; however, complete bacteriologic study of malnutrition cases is strongly indicated. Degenerative changes in the kidney with discharge of a hyaline material into the tubules was observed in about one-half of the cases. (Summary and Conclusions)