The basidiomycete Oncobasidium theobromae was identified as the cause of a devastating disease of cacao named vascular-streak dieback (VSD) in Papua New Guinea in the 1960s. VSD now causes losses among cacao seedlings and kills branches in mature cacao trees throughout Southeast Asia and parts of Melanesia. The characteristic symptoms include a green-spotted chlorosis and fall of leaves beginning on the second or third flush behind the stem apex, raised lenticels, and darkening of vascular traces at the leaf scars and infected xylem. Eventually complete defoliation occurs and, if the fungus spreads to the trunk, the tree will die. O. theobromae is a highly specialized, near-obligate parasite of cocoa. It is a windborne, leaf-penetrating, vascular pathogen, and may have evolved as an endophyte on an as yet unidentified indigenous host. The rate of disease spread on cocoa is limited because basidiocarps develop only on fresh leaf scars during wet weather, and basidiospores remain viable for a few hours on the night they are shed. Consequently, very few new infections occur beyond 80-m from diseased trees. Transmission of the disease through seed or infected cuttings has not been demonstrated. Strict quarantine measures applied to the movement of intact plants are crucial in reducing spread of the disease. Integrated management, including the planting of less susceptible genotypes, nursery construction and management, canopy pruning and shade management, provides effective control.