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Uvod: Bolesnici sa šećernom bolesti tipa 1 često imaju narušenu staničnu imunost i podložni su zaraznim bolestima. Cilj je ovog rada prikazati slučaj latentne tuberkulozne infekcije (LTBI) u 46-godišnje zdravstvene djelatnice (medicinske sestre na odjelu za tuberkulozu male djece) koja 20 godina boluje od šećerne bolesti tipa 1. Materijali i metode: Tuberkulinski kožni test učinjen je s 2 tuberkulinske jedinice (Tuberkulin RT-23, Statens Serum Institute, Kopenhagen, Danska). Krv za ispitivanje oslobađanja interferona gama, IFN-γ, (engl. Interferon Gamma Releasing Assay, IGRA) uzorkovana je u epruvete koje sadrže specifične antigene mikobakterija tuberkuloze (ESAT-6, CFP10 i TB7.7). Nakon inkubacije (22 sata) na 37°C u plazmi je određena koncentracija IFN-γ metodom ELISA (Qu-antiFERON-TB Gold In Tube - Cellestis Ltd., Victoria, Australia). Pozitivna kontrola bila je krv uzorkovana s mitogenom fitohemaglutininom, a negativna kontrola krv uzorkovana s heparinom. Rezultati: Tuberkulinski kožni test bio je negativan (induracija 6 mm), a nalaz otpuštanja IFN-γ iz aktiviranih limfocita (≥ 0,35 kIU/L) pozitivan. Normalna stanična imunost potvrđena je pozitivnom kontrolom. Ispitanica nema znakova aktivne tuberkuloze. Zaključak: U medicinske sestre koja boluje od šećerne bolesti tipa 1, a godinama radi s tuberkuloznim bolesnicima LTBI je dokazana testom oslobađanja IFN-γ, ali ne i tuberkulinskim kožnim testom. Unatoč dugogodišnje šećerne bolesti tipa 1, reakcija oslobađanja IFN-γ prema specifičnim tuberkuloznim antigenima je očuvana, a aktivna se tuberkuloza nije razvila., Introduction: Patients suffering from diabetes mellitus type 1 often have impaired cell-mediated immunity and are prone to infectious diseases. The aim of this paper is to present a case study on latent tuberculosis infection (LTBI) in a 46 year-old female health care worker (a nurse at the department for tuberculosis in young children) who has been having type 1 diabetes for 20 years. Materials and methods: Tuberculin skin test was performed using 2 tuberculin units (Tuberkulin RT-23, Statens Serum Institute, Copenhagen, Denmark). Blood for interferon gamma (IFN-γ) release assay, (IGRA) was sampled in test tubes containing specific antigens of mycobacterium tuberculosis (ESAT-6, CFP10 and TB7.7). After incubation (22 hours) at 37°C, IFN-γ concentration in plasma was determined by ELISA assay (QuantiFERON-TB Gold In Tube - Cellestis Ltd., Victoria, Australia). For positive control, blood was sampled by mitogene phytohemagglutinin and for negative control by heparin. Results: Tuberculin skin test was negative (induration 6 mm) and test result of IFN- γ release from activated lymphocytes (≥ 0.35 kIU/L) positive. Normal cellular immunity was confirmed by positive control sample. The subject showed no signs of active tuberculosis. Conclusion: In a nurse suffering from type 1 diabetes who has worked for years with tuberculosis patients, LTBI was detected by IFN-γ release assay rather than by tuberculin skin test. In spite of the long lasting diabetes, reaction of IFN-γ release toward specific tuberculosis antigens has been preserved and active tuberculosis has not developed.

Uvod: Opisuje se slučaj prolazne hiperfosfatazemije u 21-mjesečnog dječaka s ponavljajućom sipnjom tijekom akutnog respiracijskog infekta. Materijali i metode: Određivanje katalitičke aktivnosti alkalne fosfataze provedeno je preporučenom fotometrijskom metodom, a elektroforetsko razdvajanje izoenzima alkalne fosfataze na agaroznom gelu uz obradu seruma lektinom. Rezultati: Tijekom bolničkog liječenja dijete je imalo povećanu katalitičku aktivnost alkalne fosfataze: prvog dana 4109 U/L, šestog dana 2156 U/L. Pri kontrolnom pregledu 27. dana od prijma u bolnicu aktivnost se smanjila na 505 U/L. Elektroforetskim razdvajanjem izoenzima alkalne fosfataze dokazana je elektroforetska vrpca brža od jetreno-koštanog izoenzima, tzv. brza anodna vrpca. Zaključak: Pojava izrazito povećane katalitičke aktivnosti alkalne fosfataze uz tipičnu elektroforetsku razdiobu izoenzima u trajanju od nekoliko tjedana ukazuje na prolaznu hiperfosfatazemiju. Pravodobnim prepoznavanjem izbjegava se daljnja nepotrebna dijagnostička obrada., Introduction: A case of transient hyperphosphatasemia in a 21-month-old boy diagnosed with recurrent wheezing during acute respiratory infection is described. Materials and methods: Determination of alkaline phosphatase catalytic activity was performed by the recommended photometric method, and elec-trophoretic separation of alkaline phosphatase isoenzymes on agarose gel by serum processing with lectin. Results: During hospital treatment, increased catalytic activity of alkaline phosphatase was recorded (4109 U/L on day 1 and 2156 U/L on day 6). On control examination on day 27 of hospital admission, the value decreased to 505 U/L. Electrophoretic separation of alkaline phosphatase isoenzymes demonstrated a band faster than the hepatic-osseous isoenzyme, a fast anodal form. Conclusion: A marked increase in the alkaline phosphatase catalytic activity with typical electrophoretic isoenzyme pattern persisting for several weeks points to transient hyperphosphatasemia. Additional unnecessary diagnostic work-up can be obviated by timely recognition of the phenomenon.