Latent Tuberculosis with False Negative Skin Test in Guatemalan Migrant Adolescent

Patricio Ruano, MS3 – Michigan State University, College of Human Medicine | ruanopat@msu.edu | Primary Care Leadership Program | Clinica Monesor Oscar Romero, Los Angeles CA

Migrant patients who enter the United States outside of official routes are especially vulnerable due to a lack of standardized care practices in screening for disease typically affecting migrant populations. Clinicians who encounter migrant patients, especially within 30 days of arrival, must be prepared to screen for disease in alignment with refugee health. Tuberculosis (TB) , a pulmonary infectious disease, is seen in higher incidences among patients living in high-humid and low-altitude environments. Screening for tuberculosis should be considered to be included in standardized care for migrant patients and their families. The primary screening tool for tuberculosis, the PPD Skin test, shows a lower sensitivity in This case describes a 16-year old male patient of a migrant family. In 2017, the patient newly arrived to the United states at age nine from Guatemala with no pertinent medical, surgical, or allergic history. The patient initially tested negative for a PPD skin test, read in 2017. In 2023, at age 16, the patient returned for a well child visit, subsequently tested positive for TB with the use of a QuantiFERON GOLD Assay. A chest X-Ray was ordered, which resulted negative. The patient was initiated on treatment for Latent TB Infection, consisting of Rifampin qid for 120 days. The patient was instructed to return in 7 weeks and immediately return to the ED if concerns arise. Family testing for latent TB through the use of QuantiFERON GOLD Assays was begun. This case displays the importance of long-term screening for migrant populations as a part of routine well visits. This case also shows the importance of understanding changes in sensitivities of a given test in different disease states. Should disparities in disease among recent migrant communities be addressed, the practice of clinicians encountering these patient populations must be continuously reexamined.