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Noma ( cancrum oris ) is a gangrenous disease of unknown etiology affecting the maxillo-facial region of young children in extremely limited resource countries. In an attempt to better understand the microbiological events occurring during this disease, we used phylogenetic and low-density microarrays targeting the 16S rRNA gene to characterize the gingival flora of acute noma and acute necrotizing gingivitis (ANG) lesions, and compared them to healthy control subjects of the same geographical and social background. Our observations raise doubts about  Fusobacterium necrophorum , a previously suspected causative agent of noma, as this species was not associated with noma lesions. Various oral pathogens were more abundant in noma lesions, notably  Atopobium  spp.,  Prevotella intermedia ,  Peptostreptococcus  spp.,  Streptococcus pyogenes  and  Streptococcus anginosus.  On the other hand, pathogens associated with periodontal diseases such as  Aggregatibacter actinomycetemcomitans ,  Capnocytophaga  spp.,  Porphyromonas  spp. and  Fusobacteriales  were more abundant in healthy controls. Importantly, the overall loss of bacterial diversity observed in noma samples as well as its homology to that of ANG microbiota supports the hypothesis that ANG might be the immediate step preceding noma.

Microarray Analysis of Microbiota of Gingival Lesions in Noma Patients