SERIOUS HAND SEPSIS AND DIABETES-MELLITUS - SPECIFIC TROPICAL SYNDROME WITH WESTERN COUNTERPARTS

Infection in the extremities of diabetic patients most commonly involv es the feet and, at least in western societies, is often associated wi th chronic complications of diabetes. Severe hand infection, often cul minating in amputation and even death, is, however, well-described in tropical countries, where it may not be associated with any evidence o f 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 d raw some conclusions about pathogenesis and treatment from the literat ure and from original data documenting the varying experience of hand sepsis in diabetic practice throughout Africa. (C) 1998 John Wiley & S ons, Ltd.