The \u201castonishing\u201d discovery of a new bacterium could open the door to better ways to prevent, detect and treat a fatal and disfiguring childhood disease, researchers hope.<\/p>\n
Noma, which is fatal in 90% of cases without treatment<\/a>, begins as a sore on the gums but goes on to destroy the tissues of the mouth and face.<\/p>\n It mainly affects young, poor and malnourished children, and has been called the \u201cface of poverty<\/a>\u201d. Those that survive are left with lifelong scarring and disfigurement. Data on noma is patchy, but expert estimates put case numbers at tens of thousands every year<\/a>. Most cases are reported in the Sahel region of Africa, but it also occurs in other parts of the world.<\/p>\n While it can be successfully treated with broad-spectrum antibiotics, pointing to a bacterial culprit, the precise underlying cause of noma, classified as a neglected tropical disease<\/a>, has never been established.<\/p>\n Research led by the Liverpool School of Tropical Medicine set out to study<\/a> the community of bacteria living in noma patients\u2019 mouths, using samples taken from 19 children in Nigeria.<\/p>\n Modern genetic analysis techniques revealed an apparently disturbed community of microbes, with lower levels of normal, healthy bacteria, but other strains greatly increased. Deeper analysis uncovered a previously undescribed species of Treponema bacteria in most of the noma patient samples.<\/p>\n When Angus O\u2019Ferrall, the PhD student who had put the data together and found the species in the samples, presented the results, Prof Adam Roberts, a senior author on the study, said it was \u201ca great reveal\u201d. \u201cI was astonished,\u201d he said.<\/p>\n The scientists went on to reanalyse older samples from other noma patients, and found the Treponema bacteria \u2013 currently called Treponema A \u2013 were also present in those.<\/p>\n \u201cWe don\u2019t know causality,\u201d stressed Roberts. \u201cWe don\u2019t know if it can colonise a noma wound, because of the architecture and the environment, or if it causes the noma wound.\u201d<\/p>\n The team is now trying to answer that question with a larger study that will use samples from more noma patients and healthy individuals in the same communities, across multiple countries.<\/p>\n Once noma progresses to its necrotising stage, there are only two paths for the patient, according to Roberts. Either they are treated swiftly with antibiotics \u201cand you usually get a good recovery, but massive disfiguring \u2013 and with that comes lifelong stigma and social exclusion \u2013 or death. We want to stop it reaching that point.\u201d<\/p>\n In the future, a test for children with gingivitis that reveals the presence of Treponema A could save them from either fate, Roberts hopes.<\/p>\n \u201cAt the moment, the only thing that we have is a clinical diagnosis based on symptoms. And that can be a foul smell [or] holes in the skin and the tissues,\u201d he said. \u201cBut if we know that actually Treponema A, for example, is always or 99% associated with the development of noma at the gingivitis stage then we could detect and treat prophylactically with antibiotics to stop it progressing.\u201d<\/p>\n The current treatment for noma, using broad-spectrum antibiotics, risked increasing antimicrobial resistance<\/a>, Roberts said. A targeted treatment aimed at a specific bacteria could reduce that threat.<\/p>\n And the drop in healthy bacteria seen in noma patients raised the prospect of \u201ca potential preventive intervention\u201d with probiotics, he added.<\/p>\n