Dynamic Antigen-specific T-Cell Responses after Point-Source Exposure to Mycobacterium tuberculosis

Abstract Rationale The kinetics of Mycobacterium tuberculosis–specific Th1-type T-cell responses after M. tuberculosis infection are likely to be important in determining clinical outcome. Objective To investigate the kinetics of T-cell responses, in the context of a point-source school tuberculosis outbreak, in three groups of contacts who differed by preventive treatment status and tuberculin skin test (TST) results: 38 treated TST-positive students, 11 untreated TST-positive staff, and 14 untreated students with negative or borderline TST results. Methods We used the ex vivo IFN-γ enzyme-linked immunospot assay (ELISpot) to track T cells specific for two region of difference 1 (RD1) antigens, early secretory antigenic target 6 and culture filtrate protein 10, for 18 mo after cessation of tuberculosis exposure. Main Results The treated TST-positive students had an average 68% decline in frequencies of RD1-specific IFN-γ–secreting T cells per year (p < 0.0001) and 6 of 38 students had no detectable RD1-specific T cells by 18 mo. No change in frequencies of these cells was observed in the untreated TST-positive staff (p = 0.38) and none were ELISpot-negative at 18 mo. Of the 14 untreated students, 7 were persistently ELISpot-positive (all of whom had borderline TST results), and 7 became ELISpot-negative (all but one had negative TST results) during follow-up. Conclusions The decrease in M. tuberculosis–specific T cells and their disappearance in a proportion of treated students likely reflect declining antigenic and bacterial load in vivo induced by antibiotic treatment. The observed disappearance of M. tuberculosis–specific T cells in the untreated TST-negative contacts suggests that an acute resolving infection may occur in some contacts.