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Memory T cells are hallmark of acquired immunological responses. The relationship of mycobacterial antigen-specific CD4 + memory T cell subsets with pulmonary tuberculosis was investigated.The mycobacterial antigen-specific CD4 + T cells were detected based on CD154 expression and phenotypes of memory T cell were analyzed by surface staining of CD45RA and CCR7 and flow cytometrical analysis in patients with pulmonary tuberculosis and in tuberculin-positive healthy controls. The association of antigen-specific CD4 + memory T cell subsets with disease severity and anti-TB treatment was analyzed in patients with pulmonary tuberculosis.Patients with pulmonary tuberculosis had significantly lower frequencies of antigen-specific central memory T cells (T CM ) (p=0.019) and higher frequencies of effector memory T cells (T EM ) (p=0.022) compared with tuberculin-positive healthy controls without tuberculosis. Patients with smear/culture positive results showed lower population frequencies of T CM and significantly higher frequencies of T EM (p=0.015) than those with smear/culture negative results. Treatment of TB patients with standard antibiotic regimens for more than one month led to significantly increased frequencies of T CM (p=0.031).The frequencies of mycobacterial antigen-specific T CM and T EM are associated with disease severity of pulmonary tuberculosis and T CM are associated with short-term effects of anti-TB chemotherapy.