What is the recommended screening test for tuberculosis in a Haitian immigrant with a history of BCG vaccination?

In the case of a Haitian immigrant with a history of BCG vaccination, a chest x-ray is the recommended screening test for tuberculosis (TB). The BCG vaccine, which is often given to individuals in countries with high rates of TB, can lead to false-positive results when using the PPD (purified protein derivative) skin test. This happens because the immune response triggered by the vaccine can be misinterpreted as a positive TB infection, even if there is none.

A chest x-ray serves as a valuable tool in this context because it can help identify active pulmonary TB by showing characteristic findings associated with the disease, such as cavitary lesions or consolidations, regardless of vaccination status. It effectively provides a clearer picture of the individual's lung health and potential TB infection status.

Other tests, such as sputum induction, are generally used for confirmation in suspected active TB cases but are not typically used as initial screening methods. The recommendation against screening in some cases might apply, but given the patient's history and the need for proper evaluation in immigrants from high-risk areas, a chest x-ray is a more complete approach.