Endocrine Abstracts

Introduction

The diabetic is characterized by his vulnerability to infections of the upper limb compared to the general population realizing the tropical diabetic hand. So this is a very serious problem, especially in emerging countries in tropical regions. The aim of this work is to study the clinical, therapeutic and progressive aspects of infections of the upper limb in diabetic patients.

Materials and methods

This is a cross-sectional study spread over 6 years, including diabetic patients with lesions of the upper limb who consulted in the emergency room of the Mohamed VI university hospital in Marrakech, Morocco.

Outcomes

We saw 44 diabetic patients with upper limb infection. The majority of our patients had peripheral neuropathy. The average time between consultation and onset of lesions was 15.3 days. The lesions involved several parts of the upper limb: the hand in 30 cases, the arm in 8 cases, the entire upper limb in 6 cases. Various lesions were observed, phlegmon: 17 cases, panaris: 6 cases, necrotizing fasciitis: 7 cases, erysipele: 8 cases, gangrene: 4 cases, ulceration: 1 case, anthrax: 1 case. Bacteriological study of pus was only carried out on 13 lesions. Therapeutic management consisted of intensifying insulin therapy, with strict glycemic control. Triple probabilistic intravenous antibiotic therapy was initiated and then adapted to the results of the antibiogram in patients who received a bacteriological sample. As for surgical management, drainage represented 78.6% of cases, including 5 necrosectomies in 41%.

Discussion/conclusion

Lesions of the upper limb in the diabetic concern patients most often from a low socio-economic level. The lack of intrinsic coordination between the medical and surgical structures in the management of lesions of the limbs, is not likely to favor the vital prognosis of both the limb and the patient. In some cases, these injuries have been the cause of death. Indeed, the treatment of diabetes and lesions of the limbs is not confined to a drug prescription only, but requires above all patient education; it is the cornerstone of treatment, with goals to be established consistently.