Criteria for the TDHS:
(1) The condition arises in an adult with diabetes mellitus.
(2) The patient lives in a tropical or coastal area, typically in Africa or India.
(3) Initially the patient has an infection, cellulitis or gangrene involving the hand, typically in association with an ulcer or an area of injury.
(4) The infection may follow a fulminant course with sepsis, significant disability, necessitate amputation and/or cause death.
Risk factors for significant complications:
(1) delay in seeking medical attention
(2) poorly controlled blood glucose levels >= 280 mg/dL
(3) synergistic gangrene or other fulminant infection
Interestingly peripheral neuropathy and vascular disease are not significant risk factors, which is different from diabetic foot ulcerations.
