Abstract
The tropical diabetic hand syndrome (TDHS) is a complication affecting patients with diabetes mellitus in the tropics. The syndrome encompasses a localized cellulitis with variable swelling and ulceration of the hands, to progressive, fulminant hand sepsis, and gangrene affecting the entire limb. TDHS is less well recognized than foot infections and not generally classified as a specific diabetes complication. Hand infection was first described in Nigeria in 1984. Since then, the majority of cases have been reported in the African continent and more recently in India. There is often a history of antecedent minor hand trauma (e.g. scratches or insect bites). Presentation to hospital is often delayed due to the patients’ unawareness of the potential risks, lack of concern because the initiating trauma might have been trivial, or decision to seek initial help from traditional healers. The first analytic study was done in Dar es Salaam, Tanzania, to characterize the epidemiology, clinical characteristics and risk factors of TDHS.
Independent risk factors for TDHS include poorly controlled diabetes, neuropathy, insulin treatment or malnutrition. Clinicians should be aware of these complications and be prepared to immediately admit TDHS patients to hospital for aggressive surgical intervention (i.e. debridement, pus drainage or amputation) and high-dose, intravenous, broad-spectrum antibacterial therapy that includes anti-anaerobic activity. Without prompt, aggressive treatment TDHS can lead to permanent disability, limb amputation (13% of TDHS patients require major upper limb amputation), or death. Prevention strategies include patient and staff education that focuses on proper hand care, nutrition, and the importance of seeking medical attention immediately following hand trauma regardless of the severity of the injury, or at the earliest onset of hand-related symptoms, such as redness or swelling. Prevention of permanent disability and death due to TDHS will require improved management of glycemic levels in resource-limited countries, and surgical intervention during less severe stages of the condition.
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References
Abbas ZG, Lutale J, Archibald LK, et al. Tropical diabetic hand syndrome: Dar es Salaam, Tanzania, 1998-2002. MMWR. 2002; 51: 969–70
Archibald LK, Gill GV, Abbas ZG. Fatal hand sepsis in Tanzanian diabetic patients. Diabet Med. 1997; 14: 607–10
Akintewe TA. The diabetic hand: 5 illustrative case reports. Br J Clin Pract. 1984; 38: 368–71
McLigeyo SO, Otieno LS. Diabetic ulcers: a clinical and bacteriological study. East Afr Med J. 1991; 68: 204–10
Ezeldeen K, Fahal AH, Ahmed ME. Management of hand infection in Khartoum. East Afr Med J. 1992; 69: 616–8
Akintewe TA, Akanji AO, Odunsan O. Hand and foot ulcers in Nigerian diabetics: a comparative study. Trop Geogr Med. 1983; 35: 353–6
Abbas ZG, Gill GV, Archibald LK. The epidemiology of diabetic limb sepsis: an African perspective. Diabet Med. 2002; 19: 895–9
Abbas ZG, Lutale J, Gill GV, et al. Tropical diabetic hand syndrome: risk factors in an adult diabetes population, Tanzania. Int J Infect Dis. 2001; 5: 19–23
Bajaj S, Bajaj AK. Tropical diabetic hand syndrome: Indian experience. J Assoc Physicians India. 1999; 47: 1118–9
Bosseri S, Gill G. Hand and foot sepsis in Libyan diabetic patients. Trop Doct. 1997; 27: 232–3
Lipsky BA. A current approach to diabetic foot infections. Curr Infect Dis Rep. 1999; 1: 253–60
Mandel MA. Immune competence and diabetes mellitus. II: experimental mouse studies. J Surg Res. 1979; 26: 199–205
Mandel MA. Immune competence and diabetes mellitus: pyogenic human hand infections. J Hand Surg. 1978; 3: 458–61
Wilson RM. Neutrophil function in diabetes. Diabet Med. 1986; 6: 509–12
McMahon MM, Bistrian BR. Host defenses and susceptibility to infection in patients with diabetes mellitus. Infect Dis Clin North Am. 1995; 9: 1–10
Brayton RC, Strokes PE, Schwartz MZ, et al. Effect of alcohol and various disease on leukocytes mobilization, phagocytosis and intracellular bacterial killing. N Engl J Med. 1970; 282: 123–8
Siperstein MD, Unger RH, Madison LL. Studies of muscle capillary basement membranes in normal subjects, diabetic, and prediabetic patients patients. J Clin Invest. 1968; 47: 1973–99
Boulton AJ, Kirsner RS, Vileikyte L. Clinical practice: neuropathic diabetic foot ulcers. N Engl J Med. 2004 Jul; 351 (1): 48–55
Caputo GM, Cavanagh PR, Ulbrecht JS, et al. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994; 331 (13): 854–60
McLarty DG, Pollitt C, Swai AB. Diabetes in Africa. Diabet Med. 1990; 7: 670–84
Abbas ZG, Archibald LK. Foot complications in diabetes patients with symptomatic peripheral neuropathy in Dar es Salaam, Tanzania. Diabetes Int. 2000; 10: 52–6
Banson BB, Lacy PE. Diabetic microangiopathy in human toes. Am J Pathol. 1964; 45: 41–58
Lipsky BA, Berendt AR. Principles and practice of antibiotic therapy of diabetic foot infections. Diabetes Metab Res Rev. 2000; 16 Suppl. 1: S42–6
Schaper NC, Apelqvist J, Bakker K. The international consensus and practical guidelines on the management and prevention of the diabetic foot. Curr Diab Rep. 2003 Dec; 3 (6): 475–9.
American Diabetes Association. Consensus development conference on diabetic foot wound care. Diabetes Care. 1999; 22: 1354–60
Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classifiinfections cation system: the contribution of depth, infection, and ischemia to risk of amputation. Diabet Med 1998; 21: 855-9
Wheat LJ, Allen SD, Henry M, et al.. Diabetic foot infections: bacteriologic analysis. Arch Intern Med. 1986; 146: 1935–40
Lipsky BA, Pecoraro RE, Larson SA, et al. Outpatient management of uncomplion cated lower-extremity infections in diabetic patients. Arch Intern Med. 1990; 150: 790–7
Jones V. Debridement of diabetic foot lesions. The Diabetic Foot. 1998; 3: 88–94
Gibbons GW, Eliopoulos GM. Infections of the diabetic foot. In: Kozaki GP, Hoar Jr CS, Rowbotham JL, et al., editors. Management in diabetic foot problems. Joslin Clinic and New England Deaconess Hospital. Philadelphia (PA): WB Saunders Co., 1984
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No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the contents of this manuscript. We are indebted to the staff of Abbas Medical Centre, especially to Alifiya Esmail for her excellent secretarial assistance.
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Abbas, Z.G., Archibald, L.K. Tropical Diabetic Hand Syndrome. Am J Clin Dermatol 6, 21–28 (2005). https://doi.org/10.2165/00128071-200506010-00003
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DOI: https://doi.org/10.2165/00128071-200506010-00003