Nartey Yvonne Ayerki, Donkor Augustine Boakye, Siaw Ampem Darko Jnr, Ekor Oluwayemisi Esther, Jimah Bashiru Babatunde
Department of Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
Case Rep Infect Dis. 2023 Oct 12;2023:9930291. doi: 10.1155/2023/9930291. eCollection 2023.
Carbapenem-resistant infection is a critically prioritized pathogen by the World Health Organization and a cause for growing concern due to increased mortality among hospitalised patients. Phrenic nerve palsy is a rare complication of herpes zoster infection of the C3, C4, and C5 nerve roots. We present a case of bloodstream carbapenem-resistant infection in a Ghanaian patient with HIV type 1 infection and multiple risk factors, including unilateral diaphragmatic eventration with compression atelectasis likely secondary to phrenic nerve palsy due to herpes zoster infection, consequently leading to recurrent hospital and ICU admission. In this case, we emphasize the need for clinicians in LMICs to be aware of CRAB, in order to advocate for the availability of evidence-based medicines in resource-limited settings for appropriate treatment. In addition, we illustrate the importance of a high index of suspicion for infection with carbapenem-resistant organisms such as and highlight a rare and severe complication of herpes zoster infection in the form of phrenic nerve palsy and consequent diaphragmatic eventration.
耐碳青霉烯类感染是世界卫生组织高度优先关注的病原体，由于住院患者死亡率上升，这一问题日益受到关注。膈神经麻痹是C3、C4和C5神经根带状疱疹感染的一种罕见并发症。我们报告一例1型HIV感染且有多种危险因素的加纳患者发生血流感染耐碳青霉烯类菌的病例，该患者出现单侧膈膨升伴压缩性肺不张，可能继发于带状疱疹感染所致的膈神经麻痹，进而导致反复住院和入住重症监护病房。在此病例中，我们强调低收入和中等收入国家的临床医生需要了解耐碳青霉烯类鲍曼不动杆菌，以便在资源有限的环境中倡导提供循证药物进行适当治疗。此外，我们阐述了对耐碳青霉烯类生物体感染保持高度怀疑指数的重要性，并突出了带状疱疹感染以膈神经麻痹及随之而来的膈膨升这种罕见且严重并发症的情况。
