Detection of antigen Ag85B expression is useful for the diagnosis of tuberculosis, especially for those with an antituberculosis treatment history

Am J Clin Pathol. 2023 Jul 5;160(1):62-71. doi: 10.1093/ajcp/aqad012.


Objectives: The present study used immunohistochemistry (IHC) to detect antigen Ag85B in tissue sections and aimed to evaluate its validity in histopathologic diagnosis of tuberculosis (TB).

Methods: In total, 204 patients with confirmed TB and 40 other diseases were included in the present study. Ziehl-Neelsen (Z-N) stains, IHC (anti-Ag85B), and quantitative fluorescence polymerase chain reaction were used to detect acid-fast bacilli, Mycobacterium tuberculosis (MTB) antigen, and MTB DNA.

Results: Immunohistochemistry was significantly more sensitive than Z-N stains (93.1% vs 67.2%; P < .001). The sensitivity of Z-N stains significantly correlated with anti-TB treatment history. The sensitivity of Z-N stains was lower in rifampicin (RIF)-resistant TB compared with RIF-sensitive TB (52.8% vs 69.0%; P = .091) and those without treatment history (52.8% vs 84.0%; P = .015). However, IHC was not significantly affected by treatment history (P = .410). Moreover, expression patterns of Ag85B were dependent on treatment history and commonly showed weak scattered spots in RIF-susceptible TB. Conversely, strong brown rods were often found in those with RIF-resistant TB.

Conclusions: Immunohistochemistry is a simple, sensitive technique for the diagnosis of TB, especially for those patients with treatment history. The expression pattern of Ag85B is a potential marker for evaluating anti-TB treatment response.

Keywords: diagnosis; immunohistochemistry; treatment efficacy; tuberculosis.

MeSH terms

  • Antitubercular Agents
  • Coloring Agents
  • Humans
  • Mycobacterium tuberculosis* / genetics
  • Rifampin / pharmacology
  • Rifampin / therapeutic use
  • Sensitivity and Specificity
  • Tuberculosis* / diagnosis
  • Tuberculosis* / drug therapy
  • Tuberculosis, Multidrug-Resistant* / diagnosis
  • Tuberculosis, Pulmonary* / diagnosis


  • Rifampin
  • Coloring Agents
  • Antitubercular Agents