A 34-Year-Old Woman Comes to the Office for Tuberculosis Evaluation

A 34-year-old woman comes to the office for tuberculosis evaluation.  The patient was advised to have tuberculosis testing after her father, who came to visit from Haiti a week ago and had been living with her, was found to have active pulmonary tuberculosis.  She has no history of tuberculosis or any other chronic medical conditions and takes no medications.  Tuberculin skin testing is performed and results 48 hours later are negative.  Eight weeks later, the patient returns for follow-up and says she feels healthy and has had no fever, cough, shortness of breath, or weight loss.  Physical examination shows no abnormalities.  Repeat tuberculin skin testing reveals significant skin induration around the injection site at 48 hours.  Chest radiograph reveals no parenchymal opacities, pleural effusion, or enlarged lymph nodes.  Which of the following immune effector cells are most important for control of the pathogen responsible for this patient's skin findings?

A) B lymphocytes and macrophages
B) CD4 T lymphocytes and macrophages
C) CD4 T lymphocytes and neutrophils
D) CD8 T lymphocytes and B lymphocytes
E) CD8 T lymphocytes and NK cells

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