Philippe Calain and David P. Fidler
Extensively drug-resistant tuberculosis (XDR-TB) is the latest emerging disease recognized as a global health threat. It has so far been identified in at least 27 countries covering all regions of the world except Oceania. A cohort of patients was investigated in 2005-2006 in the KwaZulu-Natal province of South Africa, revealing an exceedingly high mortality rate and a rapidly fatal evolution among identified XDR-TB cases. Such alarming features of this new form of tuberculosis seem to relate at least partly to HIV co-infection. We should, unfortunately, expect the initial spread of XDR-TB to affect HIV-hyperendemic countries, with the South-African subcontinent potentially confronting significant burdens from increasing cases, fatalities, and their attendant costs. The urgency of the XDR-TB threat can be sensed in some experts’ calls for compulsory isolation of cases, leading if necessary to forcible detention.