Tropical diabetic hand syndrome--Dar es Salaam, Tanzania, 1998-2002

Patients with diabetes mellitus have impaired immunologic responses to combat infections. Infection and ulceration of the hand is a major cause of morbidity and mortality in certain populations in Africa; however, the condition is less well recognized than foot infections and is not classified generally as a specific diabetes complication. Hand ulceration and infection in diabetic patients was first described in the United States in 1977 and in Africa in 1984. Subsequently, the majority of reported cases have been from various parts of the African continent. The term "tropical diabetic hand syndrome" (TDHS) has been used to describe diabetes among patients who have progressive, fulminant hand sepsis. More recently, TDHS has been reported among patients in India. These data suggest that TDHS occurs primarily in diabetic patients who live in tropical or coastal areas and might result in loss of hand function, amputation, or death. This report describes the characteristics of 72 patients with TDHS examined at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Early recognition by patients, prompt medical attention, and improved glycemic control might reduce the incidence of disability or death.