cThis trial was conducted to explore the safety of recombinant fusion protein ESAT6-CFP10 as a skin test reagent for the diagnosis of Mycobacterium tuberculosis infection. Twenty-four healthy adult volunteers were recruited and randomized into four groups (groups A to D) to study four increasing doses of ESAT6-CFP10. All subjects in each dose group received an intradermal injection of reagent (0.1 ml) via the Mantoux technique. Then, the vital signs of all subjects were monitored, and skin reactions around injection sites and adverse events were recorded at different detection time points after the skin test. No serious adverse events were observed in this study. A total of 3 subjects had unexpected events. One subject in group A developed subcutaneous hemorrhage 24 h after the skin test, one subject in group B was found with red spots 15 min after the skin test, and another subject in group A showed abnormity during a chest X-ray after the skin test without affecting her health. One of three adverse events (red spots) was probably related to the recombinant ESAT6-CFP10 reagent. A single dose of 1, 5, 10, or 20 g/ml of recombinant ESAT6-CFP10 as a skin test reagent for M. tuberculosis infection diagnosis is well tolerated and safe in China. (This study has been registered at ClinicalTrials.gov under registration no. NCT01999231.)A lthough tuberculosis (TB) has been a curable disease, it still remains a major global problem that seriously threatens human health. According to the WHO Global TB report 2015, there were 9.6 million new cases and nearly 1.5 million TB-related deaths in 2014 (1). Thus, exploring diagnostic techniques with high sensitivity and specificity is crucial for controlling TB development and its drug resistance.TB is caused by infection with Mycobacterium tuberculosis, an intracellular pathogen transmitted by air (2). Several in vitro assay systems based on the detection of immune reactivity against an M. tuberculosis-specific antigen have been established and widely accepted in recent years. Early secreted antigenic target 6-kDa protein (ESAT6) and culture filtrate protein of 10 kDa (CFP10), two major M. tuberculosis-specific antigens, have been reported to play key roles in the virulence of M. tuberculosis and elicit strong T-cell responses (3, 4). Interferon gamma release assays (IGRAs) based on immune recognition against ESAT6 and CFP10 have been used to help diagnose activated and latent M. tuberculosis infection (5). IGRAs have an increased specificity compared to the conventional tuberculin skin test (TST) because the antigens included in IGRAs, namely, ESAT6 and CFP10, have been selected based on their absence in many environmental nontuberculous mycobacteria and the vaccine strain Mycobacterium bovis Bacillus Calmette-Guérin (BCG), which can only be detected in a number of pathogenic mycobacteria species, including M. tuberculosis, and a minority of nontuberculous mycobacteria (Mycobacteria kansasii, Mycobacteria szulgai, Mycobacteria marinum, and Mycobacteria riyadhense), altogether l...