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Chen Y, Liu B, Chen H, Xie P, Du C, Rui S, Mei H, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. Arch Dermatol Res 2024; 316:144. [PMID: 38695894 DOI: 10.1007/s00403-024-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/08/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024]
Abstract
Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Bin Liu
- Department of Emergency, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Huan Chen
- Geriatric Medical Center, Bazhong City Central Hospital, Bazhong, 636600, China
| | - Puguang Xie
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Shunli Rui
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - Hao Mei
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, 100872, China
| | - Zixiao Duan
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Centre, Chongqing University Central Hospital, Chongqing, 400014, China.
| | - Xiaoqiu Xiao
- The Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
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Chen Y, Liu B, Huan C, Xie P, Du C, Rui S, Hao M, Duan Z, Armstrong DG, Deng W, Xiao X. Comparison of bacterial species and clinical outcomes in patients with diabetic hand infection in tropical and nontropical regions. RESEARCH SQUARE 2024:rs.3.rs-3831828. [PMID: 38260272 PMCID: PMC10802731 DOI: 10.21203/rs.3.rs-3831828/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Purpose Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. Patients and Methods A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Results Both mixed bacteria (31.2% vs. 16.6%, p=0.014) and fungi (7.5% vs. 0.8%, p=0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p=0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p=0.762) and disability (6.3% vs. 12.2%, p=0.138) were not significantly differentbetween the two regions. Conclusion Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
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Affiliation(s)
- Yan Chen
- the First Affiliated Hospital of Chongqing Medical University
| | - Bin Liu
- Chongqing University Central Hospital
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- the First Affiliated Hospital of Chongqing Medical University
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Bush D, Natuzzi E, Koburu G, Bana M, Taki F, Melly A. Tropical diabetic hand syndrome in a Solomons Islands adult: A case report of a rare complication. Int J Surg Case Rep 2023; 105:108042. [PMID: 36966714 PMCID: PMC10073875 DOI: 10.1016/j.ijscr.2023.108042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Tropical diabetic hand syndrome (TDHS) is a rare and often unrecognized complication that can lead to lifelong disability or even death among diabetic patients living in the tropics. PRESENTATION OF CASE This study reports the case of a 47-year-old male patient in the Solomon Islands who developed TDHS caused by Klebsiella pneumonia. The patient presented with symptoms of localized cellulitis of the fourth digit of the left hand after being discharged 10.5 weeks prior for an infection on the second digit of the left hand. Subsequent physical exams, surgical debridement, and patient monitoring indicated that the cellulitis spread and developed into necrotizing fasciitis. Despite serial surgical debridement and a fasciotomy, as well as administration of antidiabetic agents and antibiotics, the patient developed sepsis and died forty-five days post-admission. DISCUSSION Medication shortages, late presentation, and failure to pursue aggressive surgery increases risk of TDHS patient morbidity and mortality. CONCLUSION TDHS requires early detection and presentation, aggressive surgical management, and efficient administration of antidiabetic agents and intravenous antibiotics.
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Affiliation(s)
- Dylan Bush
- Ministry of Health & Medical Services, Honiara, Solomon Islands.
| | - Eileen Natuzzi
- Solomon Islands Program, Australia & New Zealand Gastroenterology International Training Association, Solomon Islands
| | - Gordon Koburu
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | - Maggie Bana
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | - Flins Taki
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | - Augustin Melly
- Ministry of Health & Medical Services, Honiara, Solomon Islands
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Onyegbutulem H, Osisanya K, Henry-Onyegbutulem P. Unrecognised Peripheral Neuropathy and Septic Hand Ulcer as First Presentation of Diabetes Mellitus in a Nigerian Woman. A Case Report and Literature Review. Niger Med J 2022; 63:489-495. [PMID: 38884038 PMCID: PMC11170255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Diabetes mellitus may for the first time present with its classical features or with long term complications which may or may not be recognised. Knowledge of diabetes mellitus and its complications, sociocultural beliefs and perception, patronage of traditional healers may influence time of presentation and hence, outcomes. We report the case of a female Nigerian food vendor, who was admitted in coma and managed for septic left-hand ulcer and incidental diabetes mellitus. She had painless peripheral neuropathy, which gave her the ''ability'' to handle hot objects. This was misconstrued as some special gift derived from a benevolent spirit, until she sustained thermal injury and a non-healing wound on her left hand. She presented to a traditional healer which delayed hospital presentation. She was eventually brought to hospital in coma and related diabetes mellitus was found. She was appropriately managed for hyperglycaemic coma and sepsis as well as wound care and was discharged to the out patients' services on appropriate drugs and life style measures.
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Affiliation(s)
- Henry Onyegbutulem
- Department of Internal Medicine, Nile University of Nigeria, Abuja, Nigeria
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Cahyani C, Prajitno JH, Siagian N. A case report of tropical diabetic hand syndrome. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.jecr.2021.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ramkumar S, Periasamy M, Bhardwaj P, Bharathi RR, Mohan M, Sabapathy SR. Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures. Indian J Plast Surg 2021; 54:289-296. [PMID: 34667513 PMCID: PMC8515347 DOI: 10.1055/s-0041-1735421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, "onset of symptoms to presentation" interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures ( p = 0 . 014). The mean difference between the "onset of symptoms to presentation" interval between the amputation/non-amputation groups (2.9 days, p = 0 . 04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0 . 02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.
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Affiliation(s)
- Sanjai Ramkumar
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Madhu Periasamy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Praveen Bhardwaj
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - R Ravindra Bharathi
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Yeh C, Kapila R, Schwartz RA. Nontropical diabetic hand syndrome: A troubling new entity. Dermatol Ther 2019; 32:e13125. [PMID: 31631451 DOI: 10.1111/dth.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022]
Abstract
The nontropical diabetic hand syndrome merits recognition as a serious hand infection and diabetic complication. Initially recognized in the tropics and called tropical diabetic hand syndrome, this entity has not been previously delineated in temperate regions. Due in part to its unremarkable initial presentation, nontropical diabetic hand syndrome is neglected in temperate zones of the world yet it can result in severe morbidity and mortality among diabetic patients. It is poorly understood, needs recognition, and mandates expedited treatment since its clinical presentation is often overlooked until serious consequences occur. Inner city diabetic patients with poor glycemic control appear to be particularly susceptible to developing nontropical diabetic hand syndrome. We review this new entity and differentiate it into three clinical presentations: (Stage I) superficial erosion and ulceration; (Stage II) cellulitis and necrosis; and (Stage III) gangrene. The treatment of this new diabetic syndrome involves aggressive glycemic control and possible surgical intervention. We stress the importance of recognizing the diabetic hand syndrome as a potentially disabling and life-threatening disorder in diabetics worldwide.
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Patterns of finger sepsis and predictors of its outcome in patients with diabetic septic hand. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Yeika EV, Tchoumi Tantchou JC, Foryoung JB, Tolefac PN, Efie DT, Choukem SP. Tropical diabetic hand syndrome: a case report. BMC Res Notes 2017; 10:94. [PMID: 28193286 PMCID: PMC5307844 DOI: 10.1186/s13104-017-2405-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background Tropical 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 presentation We 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. Conclusion Though 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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Affiliation(s)
- Eugene Vernyuy Yeika
- Saint Elizabeth Catholic General Hospital and Cardiac Centre Shisong, Kumbo, Cameroon. .,Clinical Research Education Networking and Consultancy, Douala, Cameroon.
| | | | - Joyce Bei Foryoung
- Saint Elizabeth Catholic General Hospital and Cardiac Centre Shisong, Kumbo, Cameroon.,Health and Human Development Research Group, Douala, Cameroon
| | - Paul Nkemtendong Tolefac
- Health and Human Development Research Group, Douala, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Derrick Tembi Efie
- Health and Human Development Research Group, Douala, Cameroon.,Banso Baptist Hospital, Kumbo, Cameroon
| | - Siméon Pierre Choukem
- Health and Human Development Research Group, Douala, Cameroon.,Department of Internal Medicine and Paediatrics, Faculty of Health Sciences, University of Buea, Buea, Cameroon
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Raveendran S, Naik D, Raj Pallapati SC, Prakash JJ, Thomas BP, Thomas N. The clinical and microbiological profile of the diabetic hand: A retrospective study from South India. Indian J Endocrinol Metab 2016; 20:619-624. [PMID: 27730070 PMCID: PMC5040040 DOI: 10.4103/2230-8210.190539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pyogenic Infections of the hand in diabetes are largely a tropical entity and published material in the area are rather meagre. PATIENTS AND METHODS This is a retrospective study on the pattern of hand infections and involves the microbiological profile of 39 cases of diabetes hand-related infections admitted to the hospital between the years 2004 and 2010. RESULTS This study included 39 patients, among whom 23 (59%) had necrotizing fasciitis (NF), and 16 (9-abscess and 7-tenosynovitis) had nonnecrotizing infection. Among 25 culture positive patients, polymicrobial infections were isolated in 13 (52%) patients, a single organism was isolated in 9 (36%) and 3 (12%) had sterile cultures. Out of the 41 different bacterial isolates, 51.12% were Gram-negative and 48.78% were Gram-positive. Patients with NF had a higher mean glycated hemoglobin (10.83 ± 2.59 vs. 8.64 ± 1.8%, P = 0.020), when compared to the nonnecrotizing group. Patients with NF also had more polymicrobial infections (P = 0.017), and a longer duration of hospitalization when compared to patients without NF (21.8 ± 9.96 vs. 12.7 ± 14.5 days, P = 0.021). Seven (17.94%) patients required amputation of the affected digits of which six (15.38%) had NF. CONCLUSION Patients with poor glycemic control, polymicrobial infection, delay in presentation, and a prior surgical intervention at another medical center was associated with more severe necrotizing infections. The duration of hospitalization and amputation rates was greater among patients with NF.
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Affiliation(s)
- Sreekanth Raveendran
- Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Samuel C. Raj Pallapati
- Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - John Jude Prakash
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binu Prathap Thomas
- Dr. Paul Brand Centre for Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Any adult with diabetes in the tropics with hand cellulitis, infection and gangrene qualifies for tropical diabetic hand syndrome (TDHS). We reviewed a 39-year-old woman with a 3-week history of swelling of the left index finger following an insect bite. The swelling progressively increased in size, was very painful, and extended to the palm. There was no history or symptoms suggestive of chronic complications of diabetes. Random blood sugar on presentation was above 600 mg/dl using a glucometer. Examination revealed an edematous left palm draining pus from multiple sinuses, necrotic and gangrenous left index finger extending down to just above the thenar eminence. A diagnosis of TDHS in a patient with hyperosmolar state was made. She was managed accordingly and subsequently underwent aggressive debridement and desloughing. Two fingers were amputated and the wound was allowed to heal by secondary intention.
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Affiliation(s)
- TC Okpara
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - BA Ezeala-Adikaibe
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
- Department of Medicine, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria
| | - O Omire
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - E Nwonye
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
| | - J Maluze
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria
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Ince B, Dadaci M, Arslan A, Altuntas Z, Evrenos MK, Fatih Karsli M. Factors determining poor prognostic outcomes following diabetic hand infections. Pak J Med Sci 2015; 31:532-7. [PMID: 26150838 PMCID: PMC4485265 DOI: 10.12669/pjms.313.6858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 11/25/2014] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Hand ulcers are seen in a small percentage of patients with diabetes. The predisposing factors of diabetic hand varies between different countries. However, the effects of predisposing factors on prognosis are not clear in diabetic hand infections. In this study, our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus. METHODS Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, end-stage renal disease (ESRD), and trauma. Death and minor/major amputation cases during treatment were defined as poor prognosis. RESULTS Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates. CONCLUSIONS Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment.
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Affiliation(s)
- Bilsev Ince
- Bilsev Ince, MD. Department of Plastic & Reconstructive and Aesthetic Surgery, Faculty of Meram Medicine, Necmettin Erbakan University, 42080 Meram, Konya, Turkey
| | - Mehmet Dadaci
- Mehmet Dadaci, MD. Department of Plastic & Reconstructive and Aesthetic Surgery, Faculty of Meram Medicine, Necmettin Erbakan University, 42080 Meram, Konya, Turkey
| | - Abdullah Arslan
- Abdullah Arslan, MD. Department of Underwater and Hyperbaric Medicine, Faculty of Meram Medicine, Necmettin Erbakan University, 42080 Meram, Konya, Turkey
| | - Zeynep Altuntas
- Zeynep Altuntas, MD. Department of Plastic & Reconstructive and Aesthetic Surgery, Faculty of Meram Medicine, Necmettin Erbakan University, 42080 Meram, Konya, Turkey
| | - Mustafa Kursat Evrenos
- Mustafa Kursat Evrenos, MD. Department of Plastic & Reconstructive and Aesthetic Surgery, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Mehmet Fatih Karsli
- Mehmet Fatih Karsli, MD. Dr. Sami Ulus Maternity-Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey
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Raimi TH, Alese OO. Tropical diabetes hand syndrome with autoamputation of the digits: case report and review of literature. Pan Afr Med J 2014; 18:199. [PMID: 25419326 PMCID: PMC4237572 DOI: 10.11604/pamj.2014.18.199.3593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 05/27/2014] [Indexed: 11/25/2022] Open
Abstract
The tropical diabetes hand syndrome is a complication affecting patients with diabetes mellitus in the tropics, and consists of localized cellulitis, swelling and ulceration of the hands which may progress to fulminant sepsis and gangrene of the whole limb. It is associated with a poor outcome. We report a 32 year old woman with tropical diabetes hand infection with autoamputation of the digits, review the relevant literature, and highlight the need for prevention and early hospital presentation in diabetics with hand infection, in order to prevent potentially crippling or fatal complications.
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Affiliation(s)
- Taiwo Hussean Raimi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Oluwole Ojo Alese
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
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Tian M, Wang X, Xiao Y, Lu S, Jiang Y. A Rare Case of Diabetic Hand Ulcer Caused by Streptococcus agalactiae. INT J LOW EXTR WOUND 2012; 11:174-6. [DOI: 10.1177/1534734612457032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study reports the case of a 71-year-old woman with type 2 diabetes whose paronychia rapidly progressed to the right middle finger and then to the whole dorsal aspect necrosis of the right hand. After admission, the diagnosis of diabetic hand ulcer was established and Streptococcus agalactiae found as the pathogen. The authors controlled glucose, used 3% hydrogen peroxide and sulfadiazine silver in routine dressing, as well as surgical debridement, topical negative pressure, and skin grafting. The wound closed in 32 days after surgery. Diabetic hand ulcer is often developed from a small wound. The wound, if neglected, will expand very quickly and may lead to amputation and even death. So early diagnosis, standardized treatment, and postoperative rehabilitation is very important.
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Affiliation(s)
- Ming Tian
- Shanghai Jiao Tong University, Shanghai, Peoples’ Republic of China
| | - Xiqiao Wang
- Shanghai Jiao Tong University, Shanghai, Peoples’ Republic of China
| | - Yurui Xiao
- Shanghai Jiao Tong University, Shanghai, Peoples’ Republic of China
| | - Shuliang Lu
- Shanghai Jiao Tong University, Shanghai, Peoples’ Republic of China
| | - Yuzhi Jiang
- Shanghai Jiao Tong University, Shanghai, Peoples’ Republic of China
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Ewezu Ngim N, Amah P, Abang I. Tropical Diabetic Hand Syndrome: report of 2 cases. Pan Afr Med J 2012; 12:24. [PMID: 22891082 PMCID: PMC3415045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 03/04/2012] [Indexed: 11/20/2022] Open
Abstract
Diabetes mellitus is known to be complicated by foot lesions. However, a few cases of hand complications have been reported in some parts of the world. The case notes of two patients who presented with this condition in our hospital were retrieved and relevant information extracted. The cases of diabetic hand complications seen in our centre are here reported to draw the attention of medical practitioners to the occurrence of this potentially debilitating and occasionally fatal condition. Appropriate counselling of diabetic patients on hand care strategies and good glycemic control are important preventive measures.
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Affiliation(s)
- Ngim Ewezu Ngim
- University of Calabar Teaching Hospital, Calabar, Nigeria,Corresponding author: Ngim Ewezu Ngim, Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Paul Amah
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Innocent Abang
- University of Calabar Teaching Hospital, Calabar, Nigeria
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Akhuemokhan K, Echekwube P, Bakpa F, Okokhere P. Tropical diabetic hand syndrome: prevention through education. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2011. [DOI: 10.1080/16070658.2011.11734390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
AIMS The aim of the study was to explore the prevalence and clinical characteristics of hand ulcer in hospitalized patients with diabetes. METHODS We analysed 17 subjects with hand ulcer among diabetic inpatients, who were admitted to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism at the West China Hospital of Sichuan University from April 2003 to December 2008. RESULTS The prevalence of diabetic hand ulcer among hospitalized patients (0.37%) was significantly lower than that of diabetic foot ulcers (9.7%, P = 0.000). The mean age was 62.1 +/- 9.4 years. The average known durations of diabetes and glycated haemoglobin (HbA(1c)) were 5.3 +/- 4.9 years and 10.9 +/- 2.4%, respectively. All patients lived in the subtropical zone. Fifteen patients (88.2%) were diagnosed with diabetic peripheral neuropathy. Ten patients had hand infection. After therapy, the ulcers healed in 13 patients (76.5%) and none of them experienced amputation. The average hospital stay for patients with local infection was characteristically longer than that for patients without infection (P = 0.012). The prognosis of the hand ulcer was poorer in the patients who had diabetes for > 3 years compared with those who had diabetes for < 3 years (P = 0.009). CONCLUSIONS Diabetic hand ulcer is a relatively rare complication of diabetes in South-West China. Long duration of diabetes, poorly controlled blood glucose, minor trauma and delayed treatment are the risk factors. Diabetic peripheral neuropathy may play an important role in the pathogenesis of hand ulcer. Early control of blood glucose with insulin and early anti-microbial therapy with appropriate antibiotics are crucial. Debridement and drainage are necessary for hand abscesses.
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Affiliation(s)
- C Wang
- Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, Sichuan, China
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