Since the first description and classification of extensively drug-resistant tuberculosis (XDR-TB) in 2007, it has been found in almost every area of the world, with South Africa being the most affected. It was linked to an increased risk of death. In certain cases, chromosomal changes in the Mycobacterium TB organism that has XDR were the most likely cause of infection. M. tuberculosis strains from the KZN and Beijing may be more virulent and/or resistant. Infection with HIV wasn’t a risk factor for contracting the disease. 

In the last five years, remarkable advancements had been made in the diagnosis of XDR-TB, early identification and treatment initiation, the acceleration of the discovery of novel anti-TB medications, and the testing of current antibiotics as part of complicated treatment regimens. It was clear that the outbreak was waning in hotspots across the world, and survival was increasing. The majority of patients with XDR-TB still had a grim prognosis, as breakthroughs in diagnosis and therapy were often inaccessible in resource-poor places where the burden is highest. Inadequate subsequent chemoprophylaxis for XDR-TB contacts jeopardized TB control. 

National TB control strategies must be based on an overall TB control strategy that includes optimal treatment completion and cure rates, HIV infection control, environmental infection control in health care settings and communities (contact tracing and early TB treatment), increased capacity and expertise of health care systems, and socioeconomic improvement. In some parts of the world, the threat of completely drug-resistant TB had already been highlighted as a natural evolution of XDR-TB.