Serious hand sepsis and diabetes mellitus: specific tropical syndrome with western counterparts

Abstract

Infection in the extremities of diabetic patients most commonly involves the feet and, at least in western societies, is often associated with chronic complications of diabetes. Severe hand infection, often culminating in amputation and even death, is, however, well-described in tropical countries, where it may not be associated with any evidence of neuropathy or arterial insufficiency. Similar cases are described in the western literature but are more often associated with more severe antecedent trauma. The literature describing hand sepsis in diabetic patients both in tropical and in western practice is reviewed and we draw some conclusions about pathogenesis and treatment from the literature and from original data documenting the varying experience of hand sepsis in diabetic practice throughout Africa.

Tropical diabetic hand syndrome- a case report with a short review

“…The most common cause of polymicrobial synergistic gangrene is a symbiotic relationship of aerobic gram negative rods in combination with different enteric anaerobes. 6 Culture of tissue biopsy specimens yields a single bacterial species in more than 75% of cases. However, the swab culture results may be polymicrobial because of contamination and cannot guide optimal antimicrobial therapy.…”

“…However, the swab culture results may be polymicrobial because of contamination and cannot guide optimal antimicrobial therapy. 6,13 The pus culture of the infected wound in our patient also revealed growth of single bacterial species in the form of methicillin resistant staphylococcus aureus sensitive to linezolid and amikacin.…”

“…A rapidly progressive synergistic gangrene (Meleney's gangrene) can develop that can affect the entire limb, resulting in a severe morbidity or even mortality without prompt and aggressive medical and surgical intervention. [5][6][7]12 TDHS has to be distinguished from a traditionally described diabetic hand syndrome in which the patient has joint limitation and thickened skin especially of the dorsum of fingers. 12 Unlike diabetic foot ulcers, there is no substantial role of peripheral vascular disease and peripheral neuropathy in the pathogenesis of TDHS.…”

“…The condition may have severe consequences including permanent disability and even death without prompt and aggressive treatment. 5,6 There have been cases of TDHS reported from India as well. 1,7,8 A middle aged poorly controlled diabetic female patient presenting as TDHS is reported here, the first case of its kind reported from the Kashmir valley.…”

A Case With Type 2 Diabetes Mellitus Complicated With Diabetic Hand and Literature Review

“…Klinik prezantasyonu lokalize bir selülitten fatal olabilecek ülsere gangrenöz bir lezyona kadar değişkenlik göstermektedir (16). Tropikal bölgeler dışında nadiren görülmektedir ve vaka bildirimi şeklinde birkaç yayın mevcuttur (17,18). Lawal ve ark.…”