FATAL HAND SEPSIS IN TANZANIAN DIABETIC-PATIENTS

Hand infections are common presentations among diabetic patients admit ted to hospital in Tanzania. The morbidity and mortality are high and patients' hospital inpatient stay tend to be prolonged because of subo ptimal therapy. We describe four diabetic patients with hand infection s and fatal outcomes. In contrast to patients with foot infections, no ne of our patients had clinical evidence of peripheral neuropathy or v ascular disease. All four patients eventually died in hospital after a cquiring hand sepsis and diabetic ketoacidosis which did not respond t o prolonged courses of intravenous insulin and antimicrobials. Literat ure review suggests such infections are at least as likely to include Cram-negative organisms as Staphylococcus aureus. Primary management s hould have included aggressive surgery with limb amputation ii necessa ry with adjunctive antimicrobial therapy. (C) 1997 by John Wiley & Son s, Ltd.