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LETTERS TO EDITOR
Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 105-106

Acral gangrene following diarrhea disease


Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria

Date of Web Publication7-Aug-2017

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjmsr.mjmsr_18_17

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How to cite this article:
Aliyu I. Acral gangrene following diarrhea disease. Muller J Med Sci Res 2017;8:105-6

How to cite this URL:
Aliyu I. Acral gangrene following diarrhea disease. Muller J Med Sci Res [serial online] 2017 [cited 2019 Jul 20];8:105-6. Available from: http://www.mjmsr.net/text.asp?2017/8/2/105/212409

Dear Editor,

Diarrhea disease occurs worldwide, but the prevalence is highest in developing countries of Africa and the Asian continents. It is a leading cause of morbidity and mortality in under five children. Diarrhea is the most common in the first 2 years of life and it is estimated that there are about 2.5 billion cases per annual.[1] The majority of these cases occur in sub-Saharan Africa and it is estimated that 800,000 African children die annually from complications arising from diarrhea disease;[2] these complications include dehydration, electrolyte derangements, and hypoglycemia. Common predispositions to diarrhea disease include the absence of portable water supply, poor personal hygiene, ignorance and poverty. However, diarrhea disease and malnutrition are often interwoven with similar risk factors,[3] but the association of diarrhea disease with gangrene is a rare event; it is possible that the gangrene in the index case may be related to anaerobic infection but the negative culture made it unlikely, prior use of antibiotics before presenting in our hospital might have influenced the culture result. Gangrene results from necrosis with purification of tissues; it is the direct consequence of impaired tissue circulation arising from occluded or damaged vessels; however, its association in the case of a 1-year-old boy who presented with diarrhea disease is poorly understood. The index case presented with passage of loose stools. He had several episodes in a day; however, there was no history of fever or vomiting; he was referred from a general hospital after been 1 week on admission. He had a deranged weight of 6 kg, both the length and the occipitofrontal conference was normal for age. He was moderately dehydrated and also had angular stomatitis, bilateral pedal edma, denuded perianal skin with gangrenous left hand and forearm [Figure 1]. The electrolyte showed hypokalemia while the full blood count and blood culture were not remarkable; his hemoglobin electrophoresis was adult type AA (AA). He had fluid resuscitation, antibiotics and correction of the electrolyte derangement. However, the gangrene extended and he progressively deteriorated, and he died on the 5th day of admission.
Figure 1: Perianal excoriation with left upper limb gangrene

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Severe acute malnutrition is an immunosuppressive disease; therefore, the absence of fever as was witnessed in the index case does not completely role out severe bacterial infection. There are few reported cases of limb gangrene with associated diarrhea disease in Gram-negative septicemia (meningococcemia). The lower limbs are mostly affected with often symmetrical distribution; but in infants, the buttocks may be affected, but involvement of the upper limbs is seen usually in older children. However, the index case had a single upper limb involvement which made it a unique presentation. Shehadi et al.[4] reported six cases of diarrhea disease associated with limb gangrene but it involved the lower limbs and most of their cases were also malnourished. Therefore, whether severe acute malnutrition (SAM) is a risk factor for gangrene in children with diarrhea disease is yet to be determined; however, there was age group similarity between the index case and that reported by King et al.[5] who was 2 months old.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
World Health Organization. Reducing Mortality from Major Childhood Killer Diseases. Mortality Country Fact Sheet; 2006. Available from: https://www.apps.who.int/chd/publications/imci/fs_180.htm. [Last accessed on 2017 Feb 12].  Back to cited text no. 1
    
2.
Yilgwan CS, Okolo SN. Prevalence of diarrhea disease and risk factors in Jos University Teaching Hospital, Nigeria. Ann Afr Med 2012;11:217-21.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: A prospective descriptive study of risk factors and outcome. PLoS One 2012;7:e38321.  Back to cited text no. 3
[PUBMED]    
4.
Shehadi SI, Slim MS, Dabbous IA. Gangrene of lower extremities in infants following acute gastroenteritis. Plast Reconstr Surg 1968;42:530-4.  Back to cited text no. 4
[PUBMED]    
5.
King RE, Marks TW, Canaan R. Meningococcemia and diarrhea with gangrene. Inter-Clinic Information Bulletin 1969;8:1-8.  Back to cited text no. 5
    


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