In 1988, while in prison, Nelson Mandela was diagnosed with tuberculosis after presenting with a pleural effusion and received treatment. 1 Battersby JD Mandela hospitalized with tuberculosis, lawyer says. The New York Times. Aug 17, 1988; (accessed Jan 13, 2014).http://www.nytimes.com/1988/08/17/world/mandela-hospitalized-with-tuberculosis-lawyer-says.html Google Scholar 2 years previously in 1986, South Africa had 269 cases of incident tuberculosis per 100 000 individuals. 2 Collie A Kustner HG The Tuberculosis Control Programme, 1985–1986. Results of the data-capturing programme instituted by the Department of National Health and Population Development and the Standing Committee on Epidemiology of the Regional Health Organisation for southern Africa. S Afr Med J. 1989; 76: 676-680 PubMed Google Scholar In 2012, the incidence was roughly 1000 cases per 100 000 individuals. 3 WHOGlobal tuberculosis report 2013. World Health Organization, Geneva2013http://www.who.int/tb/publications/global_report/en/ Google Scholar The rise in incident cases has been largely attributable to HIV infection, but is also indicative of basic difficulties in tuberculosis control. 4 Abdool Karim SS Churchyard GJ Abdool Karim Q Lawn SD HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response. Lancet. 2009; 374: 921-933 Summary Full Text Full Text PDF PubMed Scopus (342) Google Scholar Mandela was successfully treated with a short-course regimen, but now multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis require increasingly complex regimens. Although South Africa has about 18% of the global burden of laboratory-confirmed MDR tuberculosis and the highest number of confirmed XDR cases, 3 WHOGlobal tuberculosis report 2013. World Health Organization, Geneva2013http://www.who.int/tb/publications/global_report/en/ Google Scholar , 5 WHOMultidrug and extensively drug-resistant tuberculosis (M/XDR-TB): 2010 global report on surveillance and response. World Health Organization, Geneva2010http://www.who.int/tb/publications/2010/978924599191/en/ Google Scholar drug-resistant tuberculosis has emerged as a threat worldwide (notably in the former Soviet Union, China, India, and Africa). The 2013 global tuberculosis report from WHO 3 WHOGlobal tuberculosis report 2013. World Health Organization, Geneva2013http://www.who.int/tb/publications/global_report/en/ Google Scholar shows continuing progress in reduction of overall tuberculosis incidence worldwide. However, the decrease is slow: about 2% per year. Additionally, the report emphasises how little progress has been made in global control of MDR tuberculosis. Long-term outcomes of patients with extensively drug-resistant tuberculosis in South Africa: a cohort studyIn South Africa, long-term outcomes in patients with XDR tuberculosis are poor, irrespective of HIV status. Because appropriate long-stay or palliative care facilities are scarce, substantial numbers of patients with XDR tuberculosis who have failed treatment and have positive sputum cultures are being discharged from hospital and are likely to transmit disease into the wider community. Testing of new combined regimens is needed urgently and policy makers should implement interventions to minimise disease spread by patients who fail treatment. Full-Text PDF