thealthЗдравоохранение ТаджикистанаHealth care of Tajikistan0514-2415Редакция журнала «Здравоохранение Таджикистана»10.52888/0514-2515-2025-365-2-82-89thealth-653Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEКлинический случай номы на фоне глубокого иммунодефицита при ВИЧ-инфекцииClinical case of noma in the context of severe immunodeficiency due to HIV infectionhttps://orcid.org/0000-0003-0579-6223РахмановЭ. Р.RahmanovE. R.

Рахманов Эркин Рахимович, доктор медицинских наук, профессор кафедры инфекционных болезней

Душанбе

Rakhmanov Erkin Rakhimovich, Doctor of Medical Sciences, Professor of the Department of Infectious Diseases

Dushanbe

erkin_rahmonov@mail.ruhttps://orcid.org/0009-0004-2537-9923ВохидоваА. П.VohidovaA. P.

Вохидова Ануш Пайравовна, врач-инфекционист, ассистент кафедры инфекционных болезней

Душанбе

Vohidova Anush Payravovna, infectious disease specialist, assistant of the Department of Infectious Diseases

Dushanbe

anushvokhidova@gmail.comhttps://orcid.org/0000-0001-8416-1167ЦойВ. Н.TsoyV. N.

Цой Виктория Николаевна, кандидат медицинских наук, доцент кафедры инфекционных болезней

Душанбе

Tsoi Victoria Nikolaevna, candidate of medical sciences, associate professor of the department of infectious diseases

Dushanbe

vikatsoy387@gmail.comhttps://orcid.org/0000-0002-3280-6469ЁроваС. К.YorovaS. K.

Ёрова Сайёра Курбоналиевна, врач-инфекционист, заведующий отделением №3

Душанбе

Yorova Sayora Kurbonalievna, infectious disease specialist, head of department No. 3

Dushanbe

sayora.yorova.85@mail.ruhttps://orcid.org/0009-0000-2811-2889ПачаджановаХ. Н.PachajanovaH. N.

Пачаджанова Хусния Набиджановна, врач-инфекционист, старший преподаватель кафедры инфекционных болезней

Душанбе

Pachajanova Khusniya Nabidzhanovna, infectious disease specialist, senior lecturer of the Department of Infectious Diseases

Dushanbe

husniya.pachadjanova@gmail.comhttps://orcid.org/0009-0004-1790-306XКурбоноваИ. Ш.QurbonovaI. Sh.

Курбонова Ибодат Шеровна, ассистент кафедры судебной медицины

Душанбе

Kurbonova Ibodat Sherovna, assistant at the Department of Forensic Medicine

Dushanbe

ibodat.qurbonova@mail.ruГОУ «Таджикский государственный медицинский университет имени Абуали ибни Сино»ТаджикистанSEI Avicenna Tajik State Medical UniversityTajikistanГУ «Городская клиническая инфекционная больница г. Душанбе»ТаджикистанSI City Clinical Infectious Diseases Hospital of DushanbeTajikistan202523072025028289Copyright © Рахманов Э.Р., Вохидова А.П., Цой В.Н., Ёрова С.К., Пачаджанова Х.Н., Курбонова И.Ш., 20252025Рахманов Э.Р., Вохидова А.П., Цой В.Н., Ёрова С.К., Пачаджанова Х.Н., Курбонова И.Ш.Rahmanov E.R., Vohidova A.P., Tsoy V.N., Yorova S.K., Pachajanova H.N., Qurbonova I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zdrav.tj/jour/article/view/653

В статье описан клинический случай успешного лечения номы (cancrum oris) у 51-летней пациентки с ВИЧинфекцией в поздней стадии. На фоне тяжёлого иммунодефицита (CD4 — 25 кл/мкл, вирусная нагрузка — 22,4 млн копий/мл) развилось обширное язвенно-некротическое поражение мягких тканей нижней губы и подбородка. Микробиологическое исследование выявило ассоциацию Fusobacterium spp., Staphylococcus aureus и Candida albicans. Проведена комплексная терапия: антибактериальные и противогрибковые препараты, симптоматическое лечение, нутритивная поддержка и антиретровирусная терапия. Это привело к клиническому выздоровлению, восстановлению кожных покровов без необходимости хирургического вмешательства. Через 6 месяцев от начала лечения достигнута стойкая иммунологическая и вирусологическая ремиссия (CD4 — 425 кл/мкл, вирусная нагрузка — 36 копий/мл). Случай подчёркивает значение своевременного начала антиретровирусной терапии и комплексного подхода к лечению тяжёлых оппортунистических инфекций у ВИЧ-инфицированных пациентов.

This article describes a clinical case of successful treatment of noma (cancrum oris) in a 51-year-old female patient with late-stage HIV infection. An extensive ulcerative-necrotic lesions of the soft tissues of the lower lip and chin developed against the background of severe immunodeficiency (CD4 count: 25 cells/μL, viral load: 22.4 million copies/ mL). Microbiological testing identified polymicrobial infection with Fusobacterium spp., Staphylococcus aureus, and Candida albicans. A comprehensive treatment strategy included antibacterial and antifungal medications, symptomatic care, nutritional support, and antiretroviral therapy. This approach led to complete clinical recovery of the affected skin restoration without the need for surgical intervention. At six months post-treatment initiation, sustained immunological and virological remission was achieved (CD4 count: 425 cells/μL, viral load: 36 copies/mL). Six months after the initiation of therapy, the patient achieved sustained immunological and virological remission (CD4 count: 425 cells/μL; viral load: 36 copies/mL). This case underscores the importance of timely initiation of ART and an integrated approach to managing severe opportunistic infections in people living with HIV.

нома (cancrum oris)ВИЧ-инфекцияоппортунистические инфекцииантиретровирусные препаратыиммунодефицитное состояниеантибактериальная терапияnoma (cancrum oris)HIV infectionopportunistic infectionsantiretroviral therapyimmunodeficiencyantibacterial treatmentReferencesAdams-Ray W.E., James J.H. Cancrum oris: functional and cosmetic reconstruction in patients with ankylosis of the jaws. Br J Plast Surg. 1992; 45(3):193-8.Adams-Ray W.E., James J.H. Cancrum oris: functional and cosmetic reconstruction in patients with ankylosis of the jaws. Br J Plast Surg. 1992; 45(3):193-8.Adeniyi S.A., Awosan K.J. Pattern of Noma (Cancrum Oris) and Its Risk Factors in Northwestern Nigeria: A Hospital-Based Retrospective Study. Ann Afr Med. 2019; 18(1):17–22. PMID: 30729928 https://doi.org/10.4103/aamAdeniyi S.A., Awosan K.J. Pattern of Noma (Cancrum Oris) and Its Risk Factors in Northwestern Nigeria: A Hospital-Based Retrospective Study. Ann Afr Med. 2019; 18(1):17–22. PMID: 30729928 https://doi.org/10.4103/aamAdekeye E.O., Ord R.A. Cancrum oris: principles of management and reconstructive surgery. J Maxillofac Surg. 1983;11:160-70.Adekeye E.O., Ord R.A. Cancrum oris: principles of management and reconstructive surgery. J Maxillofac Surg. 1983;11:160-70.Bagewadi S.B., Awasthi U.R., Mody B.M., Suma G.N., Garg S. Bony fusion of the maxilla and mandible as asequelae of noma: A rare case report. Imaging Sci Dent. 2015;45(3):193–8. https://doi.org/10.5624/isd.2015.45.3.193 PMID: 26389063Bagewadi S.B., Awasthi U.R., Mody B.M., Suma G.N., Garg S. Bony fusion of the maxilla and mandible as asequelae of noma: A rare case report. Imaging Sci Dent. 2015;45(3):193–8. https://doi.org/10.5624/isd.2015.45.3.193 PMID: 26389063Brady-West D.C., Richards L., Thame J., Moosdeen F., Nicholson A. Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy induced neutropenia. West Indian Med J. 1998 Mar 1; 47(1):33–4. PMID: 9619095Brady-West D.C., Richards L., Thame J., Moosdeen F., Nicholson A. Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy induced neutropenia. West Indian Med J. 1998 Mar 1; 47(1):33–4. PMID: 9619095Chidzonga M.M. Noma (cancrum oris) in human immunodeficiency virus/acquired immune deficiency syndrome patients. J Oral Maxillofac Surg. 1996;54:1056-60.Chidzonga M.M. Noma (cancrum oris) in human immunodeficiency virus/acquired immune deficiency syndrome patients. J Oral Maxillofac Surg. 1996;54:1056-60.Chidzonga M.M., Mahomva L. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg. 2008;66:475-85.Chidzonga M.M., Mahomva L. Noma (cancrum oris) in human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV and AIDS): clinical experience in Zimbabwe. J Oral Maxillofac Surg. 2008;66:475-85.Coupe M.H., Johnson D., Seigne P., Hamlin B. Airway management in reconstructive surgery for noma (cancrum oris). Anesth Analg. 2013;117(1):211–8.Coupe M.H., Johnson D., Seigne P., Hamlin B. Airway management in reconstructive surgery for noma (cancrum oris). Anesth Analg. 2013;117(1):211–8.Enwonwu C.O., Falkler W.A. Jr, Idigbe E.O., et al. Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection. Am J Trop Med Hyg. 1999;60:223-32.Enwonwu C.O., Falkler W.A. Jr, Idigbe E.O., et al. Pathogenesis of cancrum oris (noma): confounding interactions of malnutrition with infection. Am J Trop Med Hyg. 1999;60:223-32.Enwonwu C.O. Noma (orofacial gangrene). Editorial. Int J Dermatol. 2005;44:707.Enwonwu C.O. Noma (orofacial gangrene). Editorial. Int J Dermatol. 2005;44:707.Farley E.S., Amirtharajah M., Winters R.D., Taiwo A.O., Oyemakinde M.J., Fotso A., et al. Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children’s Hospital, Sokoto, Nigeria. Trans R Soc Trop Med Hyg. 2020;114(11):812–819. https://doi.org/10.1093/trstmh/traa061 PMID: 32785671Farley E.S., Amirtharajah M., Winters R.D., Taiwo A.O., Oyemakinde M.J., Fotso A., et al. Outcomes at 18 mo of 37 noma (cancrum oris) cases surgically treated at the Noma Children’s Hospital, Sokoto, Nigeria. Trans R Soc Trop Med Hyg. 2020;114(11):812–819. https://doi.org/10.1093/trstmh/traa061 PMID: 32785671Marck K.W. Cancrum oris and noma: some etymological and historical remarks. Br J Plast Surg. 2003;56(6):524–527. https://doi.org/10.1016/s0007-1226(03)00224-8 PMID: 12946368Marck K.W. Cancrum oris and noma: some etymological and historical remarks. Br J Plast Surg. 2003;56(6):524–527. https://doi.org/10.1016/s0007-1226(03)00224-8 PMID: 12946368Marck K.W. A history of noma, the “Face of Poverty”. Plast Reconstr Surg. 2003;111(5):1702-7.Marck K.W. A history of noma, the “Face of Poverty”. Plast Reconstr Surg. 2003;111(5):1702-7.Montandon D., Lehmann C., Chami N. The surgical treatment of noma. Plast Reconstr Surg. 1991;87(1):76- 86.Montandon D., Lehmann C., Chami N. The surgical treatment of noma. Plast Reconstr Surg. 1991;87(1):76- 86.Ogbureke K.U.E., Ogbureke E.I. NOMA: A Preventable “Scourge” of African Children. Open Dent J. 2010;4:201–6. https://doi.org/10.2174/1874210601004010201 PMID: 21243072Ogbureke K.U.E., Ogbureke E.I. NOMA: A Preventable “Scourge” of African Children. Open Dent J. 2010;4:201–6. https://doi.org/10.2174/1874210601004010201 PMID: 21243072Woon C.Y.L., Sng K.W.E., Tan BK, Lee S.T. CASE REPORT Journey of a Noma Face. Eplasty. 2010;10:49. PMID: 20628471.Woon C.Y.L., Sng K.W.E., Tan BK, Lee S.T. CASE REPORT Journey of a Noma Face. Eplasty. 2010;10:49. PMID: 20628471.

The authors declare that there are no conflicts of interest present.