three or more of the six classes of second-line drugs, is no longer used, but may be referred to in older publications. south african epidemic xdr-tb was first widely publicised following the report of an outbreak in south africa in 2006. 53 patients in a rural hospital in tugela ferry were found to have xdr-tb of whom 52 died. the median survival from sputum specimen collection to death was only 16 days and that the majority of patients had never previously received treatment for tuberculosis suggesting that they had been newly infected by xdr-tb strains, and that resistance did not develop during treatment. this was the first epidemic for which the acronym xdr-tb was used, and although tb strains that fulfill the current definition have been identified retrospectively, this was the largest group of linked cases ever found. since the initial report in september 2006, cases have now been reported in most provinces in south africa. as of 16 march 2007, there were 314 cases reported, with 215 deaths. it is clear that the spread of this strain of tb is closely associated with a high prevalence of hiv and poor infection control; in other countries where xdr-tb strains have arisen, drug resistance has arisen from mismanagement of cases or poor patient compliance with drug treatment instead of being transmitted from person to person. it is now clear that the problem has been around for much longer than health department officials have suggested, and is far more extensive.