Foot note Tanzania

Tropical Diabetic Hand Syndrome (TDHS)

The tropical diabetic hand syndrome (TDHS) is a complication affecting patients with diabetes mellitus in the tropics. The syndrome encompasses localized cellulites with variable swelling and ulceration of the hands, to progressive, fulminant hand sepsis, and gangrene affecting the entire limb.

TDHS is less well recognized than foot infections and not generally classified as specific diabetes complications. Hand infection was first described in Nigeria in 1984. Since then, the majority of cases have been reported in the African continent and more recently in India. There is often a history of antecedent minor hand trauma (e.g. scratches or insect bites).  Presentation to hospital is often delayed due to the patients’ unawareness of the potential risks, lack of concern because the initiating trauma might have been trivial, or decision to seek initial help from traditional healers.

The first analytic study was done in Dar es salaam, Tanzania, to characterize the epidemiology, clinical characteristics and risk factors of TDHS. Independent risk factors for TDHS include poorly controlled diabetes, neuropath, insulin treatment or malnutrition. Clinicians should be aware of these complication and be prepared to immediately admit TDHS patients to hospital for aggressive surgical intervention (i.e. debridement, pus drainage or amputation) and high-dose, intravenous, broad-spectrum antibacterial therapy that includes anti-anaerobic activity. Without prompt, aggressive treatment TDHS can lead to permanent disability, limb amputation (13% of TDHS patients require major upper limb amputation), or death.

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Prevention strategies include patient and staff education like step by step program that focuses on proper hand care, nutrition, and the importance of seeking medical attention immediately following hand trauma regardless of the severity of the injury, or at the earliest onset of hand-related symptoms, such as redness or swelling.  Prevention of permanent disability and death due to TDHS will require improved management of glycemic levels in resource-limited countries, and surgical intervention during less severe stages of the condition.

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Dr. Zulfiqarali G. Abbas, MMed
Consultant Physician, Endocrionologist, Diabetologist
Chair, Pan-African diabetic foot study group

  1. Abbas ZG, Archibald LK. Tropical diabetic hand syndrome: epidemiology, pathogenesis, and management. Am J Clin Dermatol 2005;6(1):21-28
  2. Abbas ZG, Lutale JK, Archibald LK, et al. Tropical diabetic hand syndrome: Dar es Salaam, Tanzania, 1998 – 2002. MMWR 2002;(51):969-70
  3. Abbas ZG, Lutale JK, Archibald LK. Tropical diabetic hand syndrome: risk factors in an adult diabetic population, Tanzania. Int J Infect Dis 2001;(5):19-23

November 2014