背景:Noma是一种研究不足的疾病,会导致发展中国家儿童严重的面部组织破坏,但原因仍然未知。我们旨在确定与坏疽性疾病相关的流行病学和微生物学危险因素。
方法:我们做了一个前瞻性的,匹配,2001年8月1日至2006年10月31日在尼日尔进行了病例对照研究,对12岁以下儿童进行了病例对照研究,以评估急性noma的危险因素。包括所有急性坏疽病例,每个病例的四个对照根据年龄和家乡进行匹配。在纳入研究时获得了流行病学和临床数据。我们用条件逻辑回归模型进行了配对分析。
结果:我们包括82例病例和327例对照。与noma相关的独立危险因素是:严重发育迟缓(比值比[OR]4·87,95%CI2·35-10·09)或消瘦(2·45,1·25-4·83);母亲先前怀孕的次数很多(1·16,1·04-1·31);呼吸道疾病的存在,腹泻,或过去3个月发烧(2·70,1·35-5·40);以及家中没有鸡(1·90,0·93-3·88)。纳入微生物数据后,梭菌比例降低(4·63,1·61-13·35),Capnocytophaga(3·69,1·48-9·17),奈瑟氏菌(3·24,1·10-9·55),和Spirochaeta在口中(7·77,2·12-28·42),普雷沃氏菌的比例增加(2·53,1·07-5·98),与坏疽性口炎有关.我们在病例中没有鉴定出特定的单一细菌或病毒病原体。
结论:Noma与严重贫困和口腔微生物群改变的指标相关。特定细菌共生的优势表明与细菌多样性降低相关的口腔微生物群的改变。
背景:GertrudeHirzelFoundation。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
BACKGROUND: Gertrude Hirzel Foundation.