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Résumé

Le noma est une stomatite gangreneuse à point de départ parodontal causant des destructions sévères des tissus mous et des os. Sa pathogénie est multifactorielle et les thromboses, les vascularites, l'infection locale et la nécrose gingivale sont autant de facteurs favorisants. Cette pathologie est classiquement l'apanage de l'enfant malnutri en zone tropicale au décours d'une maladie infectieuse. Plus récemment, des cas ont été décrits chez le sujet âgé et l'adulte immunodéprimé. La chirurgie plastique et reconstructive nécessaire pour corriger les mutilations et les séquelles est rarement à la portée des structures sanitaires locales. Nous rapportons une observation de noma chez un sujet VIH1 séropositif au Centre Hospitalier de Bobo-Dioulasso (Burkina Faso). Le noma était la manifestation principale chez ce travailleur immigré rentrant de Côte d'Ivoire. L'évolution a été marquée par une gangrène faciale extensive et des surinfections bactériennes itératives et a été fatale malgré les soins médicaux et le nettoyage chirurgical. La pathogénie et la prise en charge médicale et psychosociale sont discutées à la lumière d'une revue de la littérature.

Abstract
Noma and HIV infection : a case report from Bobo-Dioulasso National Hospital (Burkina Faso)

Noma (Cancrum oris) is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles. Recently, cases have been reported in adults especially elderly patients or during immunodeficiency states. Reconstructive surgery is often necessary to deal with destruction and sequel but is rarely accessible in developing countries.
We report one case of noma (cancrum oris) in an HIV seropositive patient at the National Hospital in Bobo-Dioulasso. The noma was inaugural of AIDS in a 40 years old labourer coming back from Ivory Coast and no major opportunistic infection was associated. The course was fulminant leading to extensive facial gangrene with recurrent bacterial infections. The disease was fatal in this depressive, malnourished and diarrhoeic patient despite local surgical treatment, prolonged antibiotherapy and supportive care. Pathogenic mechanisms, management and preventive issues are discussed.