American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the best method for testing for latent tuberculosis in previously vaccinated patients?

Skin tuberculin test
Blood cultures
Interferon-γ release assay
Chest X-ray

The correct answer is: Interferon-γ release assay

The best method for testing for latent tuberculosis (TB) in previously vaccinated patients is the Interferon-γ release assay (IGRA). This is because the IGRA is specifically designed to detect the immune response to specific TB antigens and is not affected by prior vaccination with the bacillus Calmette-Guérin (BCG) vaccine. Unlike the tuberculin skin test (TST), which may yield false-positive results in individuals who have received the BCG vaccine, the IGRA provides a more reliable assessment of latent TB in vaccinated individuals. The testing process involves drawing blood and measuring the immune response, which gives a clearer indication of TB infection status. In contrast, options such as blood cultures are primarily used to diagnose active TB rather than latent infection. Chest X-rays are valuable for assessing active TB disease but do not provide information on whether a person has latent TB. Therefore, the use of IGRA is preferred for its specificity and reliability in vaccinated individuals when screening for latent TB infection.