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Background  Tuberculin skin testing is simple and relatively inexpensive, but the specificity of PPD is affected by BCG vaccination.    Objective  Determine optimal dose and specificity of recombinant ESAT-6 and CFP-10 (C-Tb) produced in  Lactococcus lactis  for diagnosis of  M. tuberculosis  infection.    Methods  In a dose finding phase I trial 0.01 or 0.1 µg preserved and unpreserved C-Tb was injected by Mantoux technique in 38 patients with active tuberculosis and induration responses measured. In a phase II specificity trial in 151 uninfected, BCG vaccinated participants 0.1 µg C-Tb was compared to 2 TU PPD.    Results  0.1 µg C-Tb gave a median induration of 15 mm after 2 days. Phenol preservation did not affect the response. The specificity of C-Tb was 99.3% (95% CI 96–100%) regarding indurations ≥5 mm as a positive outcome. This was higher than the specificity of PPD (63% using a cut-off of 5 mm or 92% using a cut-off of 15 mm to adjust for non-specific BCG responses). Local adverse reactions following C-Tb injection included transient itching and discomfort as expected components of the immune response.    Conclusion  C-Tb offers a simple and convenient skin test to diagnose  M. tuberculosis  infection using a single, universal cut-off unaffected by BCG vaccination.    Trial Registration  ClinicalTrials.gov  NCT01033929  and  NCT01241188 .

Randomised Clinical Trial Investigating the Specificity of a Novel Skin Test (C-Tb) for Diagnosis of M. tuberculosis Infection