Care of the patient with XDR-TB who has failed treatment.

In early 2014, a man aged 46 years with HIV and a distant history of tuberculosis treatment was admitted to the communal medical ward of a district hospital in rural KwaZulu-Natal, South Africa, in respiratory distress. He was initially treated empirically for bacterial pneumonia. Sputum taken on day 5 of his hospital stay was positive for acid-fast bacilli with rifampicin resistance on line probe assay. After 11 days in hospital, his doctors learned that he had previously failed treatment for extensively drug-resistant (XDR) tuberculosis and had been discharged without being given further treatment options. He had been living at home with his wife, elderly mother, and five young children, sharing a bedroom with several other family members. The patient and his family believed he had successfully completed treatment; they did not understand his prognosis or the transmissibility of his disease.