Tropical diabetic hand syndrome among diabetic patients attending endocrine clinic of Ahmadu Bello University Teaching Hospital, Shika Zaria, North Central Nigeria

Okpe, Innocent; Amaefule, K E; Dahiru, I L; Lawal, Yaqub; Adeleye, A O; Bello-Ovosi, Beatrice

doi:10.4103/2384-5147.184378

Cited by 5 publications

(9 citation statements)

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“…TDHS is a rare but debilitating cause of morbidity, hospital admissions, and mortality amongst patients with diabetes, especially for patients in the tropics. 7,8 Compared with diabetic foot infection, TDHS seems to be less prevalent. [7][8][9] Some notable risk factors for TDHS include trauma, poor glycaemic control, and malnutrition.…”

Section: Discussionmentioning

confidence: 99%

“…It is pertinent to note that lack of patient education on the subject matter, late presentation for care, delay in initiation of broadspectrum antibiotics (preferably intravenous antibiotics), poor glycaemic control, and inadequate wound care can significantly affect the patient's prognosis. [5][6][7][8] Key Points 1. Tropical diabetic hand syndrome, which manifests in swelling and ulceration of the hand and can lead to deformity, disability, amputation, and death, mainly affects patients with diabetes living in the tropics.…”

Section: Introductionmentioning

confidence: 99%

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Tropical Diabetic Hand Syndrome: A Case Report and Literature Review

Emanah¹,

Ewelukwa²,

Emehinola³

et al. 2022

EMJ Diabet

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Tropical diabetic hand syndrome (THDS) is an acute complication that mainly affects patients with diabetes living in the tropics. The cause is usually unknown, but it is often preceded by minor trauma to the hand. Other risk factors for TDHS are poor glycaemic control, poorly treated wounds, malnutrition, and diabetic neuropathy. Early signs include swelling and ulceration of the hand. It can rapidly progress to sepsis and may further worsen, leading to deformity, disability, and amputation. If not treated promptly, death may occur. Unlike diabetic foot ulcer, TDHS often goes unreported. Here is a case of a 39-year-old female and a known patient with diabetes who presented to the outpatient department with swelling and tenderness of the left hand, along with foul-smelling purulent discharge. It began after the patient peeled off a patch of scaly, thickened skin over the distal part of their middle finger. Investigations showed high blood sugar and slightly increased leukocyte count. The patient was started on antihyperglycaemic medications and intravenous antibiotics. Urgent surgical debridement was done, which led to amputation of the middle finger. Thereafter, the patient showed significant improvement and was discharged with follow-up instructions. This case report emphasises the importance of timely intervention in cases of tropical diabetic hand syndrome, and the need for adequate patient education on this issue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tropical Diabetic Hand Syndrome: A Case Report and Literature Review

Emanah¹,

Ewelukwa²,

Emehinola³

et al. 2022

EMJ Diabet

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“…Hence, prompt incision and drainage are beneficial for those with abscesses and administration of broad-spectrum antibiotics, which covers for anaerobic organisms. [ 6 7 9 ] Health education is very crucial, and this consists of proper hand care, nutrition, and early presentation in the hospital following any form of trauma to the hand, no matter less severity. Improved glycaemic control, early presentation, and early surgical intervention will prevent limb amputation and death.…”

Section: Discussionmentioning

confidence: 99%

Tropical diabetic hand syndrome—Report of 2 cases

Ngim

Amah²,

Abang³

2021

J West Afr Coll Surg

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Tropical diabetic hand syndrome (TDHS) is not a commonly reported complication of diabetes mellitus. It was first reported in Nigeria in 1984[ 1 ] but prior to that time, in 1977, it was described in the United States of America.[ 2 ] Several other cases are now being reported in other countries of Africa and India. It is termed TDHS because it affected patients with diabetes mellitus in the tropics. It presents with cellulitis, ulceration, and fulminant sepsis of the hand, which may progress to gangrene, and many have lost the digits as seen in one of our patients or sometimes the whole hand. Many of these patients present very late as the onset of the condition is usually due to minor trauma to the hand like a pin prick or little scratches, which result in cellulitis are treated by patent medicine dealers until the sepsis and possibly gangrene in some cases sets in.

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“…Hand infections and ulceration remain a major cause of morbidity and mortality amongst diabetics in the tropics [ 4 , 7 ]. Abbas et al in 2001 reported a mortality rate of 13% from overwhelming sepsis due to TDHS [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…TDHS occurs primarily in diabetic patients who live in the tropical or coastal areas [ 3 ]. The outcome of TDHS may range from limb deformity to amputation and even death [ 4 ]. Independent risk factors for TDHS include poorly controlled diabetes, peripheral neuropathy, female sex, insect bites, hand trauma, low socioeconomic status, residence in coastal areas and late presentation to the hospital [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Tropical diabetic hand syndrome: a case report

et al. 2017

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BackgroundTropical diabetic hand syndrome describes a complex hand sepsis affecting patients with diabetes across the tropics and often results from a trivial hand trauma. The clinical presentation of this syndrome is variable and ranges from localised swelling and cellulitis, with or without ulceration of the hand to progressive fulminant hand sepsis, and gangrene affecting the entire limb which may be fatal. Tropical diabetic hand syndrome could lead to permanent disability and death as a result of delay in presentation, late diagnosis and late medical and surgical intervention. This indexed case acts as an eye opener for physicians to the existence of this hand sepsis.Case presentationWe report the case of a 57 year-old black African female diabetic who was referred to our centre for the management of a suppurating ulcer and swelling of the left hand of two weeks duration. On examination and work-up, the patient was found to have Lawal Group III left diabetic hand syndrome and was managed with parenteral antibiotics, radical debridement and the hand was eventually amputated. She died 7 days following amputation from overwhelming sepsis.ConclusionThough tropical diabetic hand syndrome is a relatively rare complication of diabetes, it can be fatal as in this case report. Early diagnosis and proper management would yield better outcome. Initial management should include aggressive intravenous broad-spectrum antibiotics with anaerobic coverage. Classification of tropical diabetic hand syndrome will assist physicians and surgeons in decision making, proper management and easy communication.

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Tropical diabetic hand syndrome among diabetic patients attending endocrine clinic of Ahmadu Bello University Teaching Hospital, Shika Zaria, North Central Nigeria

Cited by 5 publications

References 0 publications

Tropical Diabetic Hand Syndrome: A Case Report and Literature Review

Tropical Diabetic Hand Syndrome: A Case Report and Literature Review

Tropical diabetic hand syndrome—Report of 2 cases

Tropical diabetic hand syndrome: a case report

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