Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature
Hand infection in patients with diabetes: a series of 17 cases and a pooled analysis of the literature
Background/aim: The aim of this study was to report the clinical characteristics and the treatment outcomes of hand infections indiabetic patients and to review the literature.Materials and methods: The medical records of 17 patients with diabetic hand infections admitted to the Diabetic Foot Care Center oftwo different clinics from January 2012 to October 2017 were reviewed. To perform the pooled analysis, published series (32 studies)were searched in two international databases (www.scopus.com and www.pubmed.com).Results: Of the 17 patients (mean age 61.7 ± 8.5 years), 8 (47.1%) were female. All cases were type 2 diabetes mellitus. The mean durationof diabetes was 9.0 ± 5.96 years and the mean HbA1c was 7.86 ± 1.88%. There was necrosis in 8 patients (47.1%). The most commoncauses were injury during saw and hammer use in 5 patients (29.4%) and injury due to inappropriate nail cutting in 3 patients (17.6 %).Nine (52.9%) patients were operated on. No patients underwent any major amputations or died. In 32 publications, 704 patients withdiabetic hand infections were found. The average age was 53.43 years (n = 591) and 84.29% of patients (322/382) were found to havetype 2 DM. The mean duration of diabetes was 4.12 years (n = 317) and the mean HbA1c was 10.58% (n = 140). The rate of surgicaloperation was 74.59% (323/433).Conclusion: Diabetic hand injuries often occur when using hand tools such as hammers, saws, and knives, and when cutting nails. Itis necessary to use conservative treatment rather than amputation. These patients should consult experienced health care professionals.
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- Wang C, Lv L, Wen X, Chen D, Cen S, Huang H, Li X, Ran
X. A clinical analysis of diabetic patients with hand ulcer in a
diabetic foot centre. Diabet Med 2010; 27: 848-851.
- Uysal S, Arda B, Saygılı F, Taşbakan MI, Ardeniz FÖ, Şimşir
IY, Ulusoy S. A case with recurrent pyogenic infections and
neutrophil hypogranulation; caused by uncontrolled diabetes.
ANKEM Dergisi 2013; 27: 213-216 (article in Turkish with an
abstract in English).
- Ozan F, Gürbüz K, Çelik İ, Beştepe Dursun Z, Uzun E. Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turk J Med Sci 2017; 47: 1109-1116.
- Işıkgöz Taşbakan M, Yıldırım Şimşir I, Mermer S, Uysal S,
Öztürk M, Çetinkalp Ş. Intralesional epidermal growth factor
therapy for diabetic foot ulcers: an evaluation of 15 cases. Turk
J Med Sci 2017; 47: 1500-1504.
- Jalil A, Barlaan PI, Fung BK, Ip JW. Hand infection in diabetic
patients. Hand Surg 2011; 16: 307-312.
- Aydın F, Kaya A, Savran A, İncesu M, Karakuzu C, Özturk AM.
Diabetic hand infections and hyperbaric oxygen therapy. Acta
Orthop Traumatol Turc 2014; 48: 649-654.
- Mann RJ, Peacock JM. Hand infections in patients with diabetes mellitus. J Traum 1977; 17: 376-380.
- Fitzgibbons PG, Weiss AP. Hand manifestations of diabetes
mellitus. J Hand Surg Am 2008; 33: 771-775.
- Papanas N, Maltezos E. The diabetic hand: a forgotten complication? J Diabetes Complications 2010; 24: 154-162.
- Nthumba P, Cavadas PC, Landin L. The tropical diabetic hand
syndrome: a surgical perspective. Ann Plast Surg 2013; 70: 42-
46.
- Okpara TC, Ezeala-Adikaibe BA, Omire O, Nwonye E, Maluze
J. Tropical diabetic hand syndrome. Annals of Medical and
Health Sciences Research 2015; 5: 473-475.
- Francel TJ, Marshall KA, Savage RC. Hand infections in the
diabetic and the diabetic renal transplant recipient. Ann Plast
Surg 1990; 24: 304-309.
- Gill GV, Famuyiwa OO, Rolfe M, Archibald LK. Tropical diabetic hand syndrome. Lancet 1998; 351: 113-114.
- ZG Abbas, LK Archibald, WR Jarvis, G Beckles, Moore K.
Tropical diabetic hand syndrome Dar es Salaam, Tanzania,
1998-2002. MMWR 2002; 51: 969-970.
- Tiwari S, Chauhan A, Sethi NT. Tropical diabetic hand syndrome. Int J Diabetes Dev Ctries 2008; 28: 130-131.
- Tian M, Wang X, Xiao Y, Lu S, Jiang Y. A rare case of diabetic
hand ulcer caused by Streptococcus agalactiae. Int J Low Extrem Wounds 2012; 11: 174-176.
- Ewezu Ngim N, Amah P, Abang I. Tropical diabetic hand syndrome: report of 2 cases. The Pan African Medical Journal
2012; 12: 24.
- Jiang KC, Luo N, Chen YC, Wang AP. Use of maggot debridement therapy for tropical diabetic hand syndrome. J Wound
Care 2013; 22: 244-247.
- Ezeani IU, Edo AE. Case series on tropical diabetic hand syndrome. Niger J Clin Pract 2014; 17: 540-542.
- 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-
537.
- 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.
- Iyengar KP, Nadkarni JB, Gupta R, Beeching NJ, Ullah I, Loh
WY. Mycobacterium chelonae hand infection following ferret
bite. Infection 2013; 41: 237-241.
- Kour AK, Looi KP, Phone MH, Pho RW. Hand infections in
patients with diabetes. Clinical Orthopaedics and Related Research 1996; 238-244.
- Raimi TH, Alese OO. Tropical diabetes hand syndrome with
autoamputation of the digits: case report and review of literature. The Pan African Medical Journal 2014; 18: 199.
- Ayaz M, Moein R. Myocutaneous mucormycosis in a diabetic
burnt patient led to upper extremity amputation; a case report.
Bulletin of emergency and Trauma 2017; 5: 58-62.
- Liu Y, Liu Y, Wang P, Tian H, Ai J, Liu Y, Zhou Y, Liu Z, Guo
W, Yang S. Autologous bone marrow stem cell transplantation
for the treatment of postoperative hand infection with a skin
defect in diabetes mellitus: a case report. Oncol Lett 2014; 7:
1857-1862.
- Steensma EA, Ertl CW, Burke LH. Clostridium tertium isolated from a necrotizing soft tissue infection in a diabetic but
otherwise nonimmunocompromised patient. The Journal of
the American College of Certified Wound Specialists 2011; 3:
42-44.
- Benotmane A, Faraoun K, Mohammedi F, Benkhelifa T, Amani
ME. Infections of the upper extremity in hospitalized diabetic
patients: a prospective study. Diabetes Metab 2004; 30: 91-97.
- Gonzalez MH, Bochar S, Novotny J, Brown A, Weinzweig N,
Prieto J. Upper extremity infections in patients with diabetes
mellitus. J Hand Surg Am 1999; 24: 682-686.
- Pinzur MS, Bednar M, Weaver F, Williams A. Hand infections
in the diabetic patient. J Hand Surg Br 1997; 22: 133-134.
- Ahmed ME, Mahmoud SM, Mahadi SI, Widatalla AH, Shawir
MA, Ahmed ME. Hand sepsis in patients with diabetes mellitus. Saudi Med J 2009; 30: 1454-1458.
- Coppini DV, Best C. A case of hand ulceration in the diabetic
foot clinic—a reminder of hand neuropathy in ‘at risk’ patients.
Diabet Med 2000; 17: 682-683.
- Connor RW, Kimbrough RC, Dabezies EJ. Hand infections in
patients with diabetes mellitus. Orthopedics 2001; 24: 1057-
1060.
- Annabestani Z, Kassaian SE, Mohajeri-Tehrani MR, Mohseni
S, Saroukhani S, Larijani B. Retrograde trans-femoral approach
for successful percutaneous angioplasty in a diabetic patient
with ischemic hand ulcer: a case report. J Tehran Heart Cent
2013; 8: 205-209.
- Kasim KM, Bujang MA, Abdullah MAH, Huan PC, Johari J,
Ponniah JPS, Ibrahim S, Ang HL. Characteristics and outcome
of patients with hand and upper limb infection in a diabetes
patients. Int J Diabetes Dev Ctries 2015; 35: 123-128.
- Muhamad Effendi F, Miswan MF, Ibrahim MI, Rozali KN.
Clinical characteristics of diabetic patients with upper limb
and hand infections. Brunei Int Med J 2016; 12: 26-31.
- Lawal Y, Ogirima M, Dahiru I, Girei B, Salisu M. Tropical diabetic hand syndrome: surgical management and proposed classification. Arch Int Surg 2013; 3: 124-127.
- Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003;
361: 1545-1551.
- Lavery LA, van Houtum WH, Armstrong DG, Harkless LB,
Ashry HR, Walker SC. Mortality following lower extremity
amputation in minorities with diabetes mellitus. Diabetes Res
Clin Pract 1997; 37: 41-47.
- Gill G, Archibald L, Abbas ZG. Diabetic hand infection in the
tropics. Practical Diabetes International 2003; 20: 275.
- Abbas ZG, Lutale J, Gill GV, Archibald LK. Tropical diabetic
hand syndrome: risk factors in an adult diabetes population.
Int J Infect Dis 2001; 5: 19-23.
- Kaya Bicer E, Kucuk L, Kececi B, Murat Ozturk A, Cetinkaya
S, Ozdemir O, Coskunol E. Evaluation of the risk factors for
acute occupational hand injuries. Chirurgie de la Main 2011;
30: 340-344.
- Uysal S, Arda B, Tasbakan MI, Cetinkalp S, Simsir IY, Ozturk
AM, Uysal A, Ertam I. Risk factors for amputation in patients
with diabetic foot infection: a prospective study. Int Wound J
2017; 14: 1219-1224.
- Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW
et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot
infections. Clin Infect Dis 2012; 54: 132-173.