Tuberculosis (TB)is still a serious threat to global public health, causing millions of people infected every year. Mycobacterium tuberculosis (MTB) is the main pathogen causing TB. In recent years, MTB extracellular vesicles (MEVs) as important carriers for MTB-secreted Mycobacterium antigens have attracted the attention of researchers. MEVs enable MTB to secrete phospholipid, nucleic acid, lipopolysaccharide, and periplasmic component in a centralized protective mode, and interact with the host. Some progress has been made on the study of partial contents of MEVs, but the understanding of their biological mechanisms, functions, and roles in the immune responses during MTB infection is still at its early stages. This article reviews the current progress in the biogenesis of MEVs, their roles in MTB infection and immune responses regulation, and discusses their applications in vaccine development and diagnostic techniques.