PathNoma

PathNoma is a multicentre study to explore the aetiology of noma via deep metagenomic, microbiological and immunological analyses of acute noma patients.

Noma is a gangrenous infection of the oral cavity which causes rapid, widespread orofacial destruction. If untreated, death usually occurs within weeks after the onset of first symptoms. Noma mainly affects children aged between two and five years. Although a range of organisms have been identified in the oral flora of noma patients, the causal association of these organisms with the development of noma has yet to be proven. Deep shotgun metagenomic analysis may provide further elucidation of the pathologic organisms involved in noma.

We are embarking on a multi-site, five-year case control study to gain a comprehensive understanding of the pathobiology of acute noma. Study sites include Nigeria, Niger, Guinea-Bissau, and potentially DRC, Ethiopia, Madagascar, Mozambique and South Sudan.

We will enrol cases (noma patients) and controls (household family members, healthy and chronically malnourished unrelated controls). We will request participants to provide us with various samples (saliva and blood, pus and or/ tissue) and complete a short survey.

We aim to identify microbial patterns, characterise immunological function and assess the prevalence of anti-microbial resistant organisms within the oral cavity of noma patients.

The findings will be used to:

• Identify if there is an at-risk microbiome that could be altered with dental hygiene interventions
• Design diagnostics for the early detection of noma which could facilitate more timely provision of care which can prevent the later stages of noma from developing
• Develop tailored treatment for noma which could prevent AMR by reducing the spectrum of the antibiotics given to patients.

Research institutes involved in PathNoma

University of Liverpool, Médecins Sans Frontières, Noma Children’s Hospital, Liverpool School of Tropical Medicine, ISGlobal and CaixaResearch Institute.

Members

Dr Stuart Ainsworth	University of Liverpool
Dr Mohana Amirtharajah	Médecins Sans Frontières
Michael Olaleye	Médecins Sans Frontières
Professor Adam Roberts	Liverpool School of Tropical Medicine
Dr Gemma Moncunill	ISGlobal and CaixaResearch Institute
Professor Nicholas Evans	University of Liverpool