Extensively Drug Resistant (XDR) Mycobacterium tuberculosis (MTB) was first encountered in 2006. Now as we enter 2012 we learn that a strain of MTB totally resistant (TDR) to all current antimicrobials has entered the Indian sub-continent . This new strain to India, TDR-MTB first emerged in 2009 in 15 patients in Iran. In a letter to CID (http://cid.oxfordjournals.org/content/early/2011/11/24/cid.cir889.full.pdf+html) published in late December 2011 Udwadia and colleagues describe how a strain recovered from four patients was resistant to all first line (isoniazid, frifampicin, ethambutol, pyrazinamide and streptomycin) and second-line antimicrobials (ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicyclic acid, and ethionamide. While TDR-MTB is not new to the world, its emergence in India is cause for concern.