Noma au Niger: Aspects Cliniques et Prise en Charge

RESUMEIntroduction. Decrire les aspects cliniques et therapeutiques du Noma au Niger. Patients et methodes. Il s’agit d’une etude transversale retrospective realisee en 21 mois (Fevrier 2013 a Octobre 2014) chez des patients admis au service de stomatologie de l’Hopital National de Niamey et a l’ONG Hilfsaktion Noma. Nous avons inclus dans cette etude tous les patients avec diagnostic clinique prouve de noma. Le sexe, l’âge, les signes cliniques et les aspects therapeutiques etaient les variables etudiees. Resultats. Au cours de notre etude, 1135 dossiers de patients ont ete consultes dont 1000 dossiers au service de stomatologie et 135 a l’ONG Hilfsaktion noma parmi lesquels 30 etaient porteurs de noma, soit une frequence de 2,6%. Le sex ratio etait de 1,5. L’âge moyen des patients etait de 9 ans et 80% des enfants etaient dans la tranche d’âge de 0 a 15 ans. La douleur (n= 15, 50%) et la perte de substance (n=9, 30%) etaient les principaux motifs de consultation. Dix sept patients (56,7%) ont consulte a la phase aigue. L’inflammation jugale etait presente dans 8 cas (27%) et les levres etaient touchees dans 10 cas (33%). La serologie VIH obtenue chez 18 patients etait negative. Concernant la prise en charge, tous les patients ont beneficie de soins buccodentaires et 29 patients (97%) ont recu une antibiotherapie. La correction de l’etat nutritionnel a concerne seulement 8 patients (27%). Le traitement chirurgical a ete utilise chez 18 patients (60%) et la technique chirurgicale la plus utilisee etait la mecanotherapie par distracteur (7 cas soit 23%). L’evolution a ete favorable chez 28 patients (93%). Les principales complications etaient l’atteinte de la fonction vocale chez un patient (3%), la constriction des mâchoires chez trois patients (10%), la gene esthetique chez neuf patients (30%) et les pneumopathies chez deux patients (7%). Conclusion. Le noma reste present au Niger. Les resultats de la prise sont excellents si cette derniere est precoce.ABSTRACTIntroduction. To report the clinical presentation and management of Noma in our setting. Patients and methods. This was a cross sectional retrospective descriptive study carried out over 21 months (February 2013 to October 2014), that concerned patients cared in the stomatology department of the National Hospital of Niamey and to the Hilfsaktion noma NGO. All patients with proven clinical diagnosis of noma were included. Sex, age, clinical presentation, management and outcome were our variables of interest. Results. During the study period, 1135 patients were consulted, including 1000 patients at the stomatology department and 135 at the Hilfsaktion noma NGO. Among them, 30 patients (3%) had noma. The sex. ratio was 1.5. The mean age of the patients was 9 years and 24 patients (80%) were aged 0 to 15 years. Pain (15 patients, 50%) and losses of substance (9 patients, 30%) were the main reasons for consultation. Seventeen patients (56.7%) consulted in the acute phase. Jugal inflammation was the most common physical sign (8 patients, 27%). The lips were affected in 10 cases (33%). HIV serology was obtained in 18 patients and was negative. Concerning management, all patients received oral care and 29 patients (97%) received antibiotics. Correction of nutritional status covered only eight patients. Surgical treatment was done in 18 patients (60%) and the most common surgical technique was distractor mechanotherapy (7 patients, 23%. The outcome was favorable in 28 patients (93%). The main complications were vocal impairment (one patient, 3.33%, jaw constriction (3 patients, 10%), aesthetic discomfort (9 patients, 30%) and pneumonia (2 patients, 7%). Conclusion. Noma is still present in Niger The prognosis is excellent with proper early management.