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J Med Primatol. 2011 Jun;40(3):188-93. doi: 10.1111/j.1600-0684.2011.00470.x. Epub 2011 Feb 21.

Acute necrotic stomatitis (noma) associated with methicillin-resistant Staphylococcus aureus infection in a newly acquired rhesus macaque (Macaca mulatta).

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Xenotransplantation Research Center, Seoul National University Hospital, Seoul, South Korea.



A newly acquired rhesus macaque was suffering from rapid destruction of the left cheek caused by necrotizing stomatitis.


To restore reconstructive surgery and intensive care with antibiotics, wound protection, wound healing agents, and debridement were applied.


Staphylococcus aureus and Enterococcus faecalis were isolated from the culture of the lesion, and the antibiotic susceptibility test revealed methicillin-resistant Staphylococcus aureus infection. Vancomycin and ampicillin-sulbactam effectively treated the bacterial infections, and reconstructive surgery was performed once the infection was cleared. Topical application of recombinant human epidermal growth factor (rhEGF) was useful to treat exposed wound of the noma lesion.


Simian noma associated with methicillin-resistant Staphylococcus aureus (MRSA) had not previously been reported in non-human primates. Although noma associated with MRSA is hard to cure because of its rapid and destructive progress, the aggressive therapy used in this study led to the successful resolution of an acute necrotic stomatitis lesion in a rhesus macaque.

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