Introduction: Olive Quick Decline Syndrome (OQDS), first recognized in Apulia, Italy, is associated with the nutritionally fastidious, xylem-limited bacterium Xylella fastidiosa subsp. pauca sequence type 53 (ST53), and has become a major plant-health emergency for Mediterranean perennial agriculture. Methods: This narrative review synthesizes peer-reviewed and regulatory literature published from January 2013 to April 2026, while retaining older foundational studies required to interpret pathogen biology. Searches were conducted in Scopus, Web of Science, PubMed/MEDLINE and Google Scholar, complemented by EFSA, EPPO and EU regulatory documents. Evidence was appraised according to study type, reproducibility, field relevance and translational readiness. Results: The first decade of research established that OQDS is not a single pathogen-host interaction but a pathosystem involving an introduced xylem-limited bacterium, native xylem-feeding vectors, cultivar-dependent host responses, orchard context and the xylem microbiome. Genomic plasticity, biofilm formation and xylem vessel connectivity contribute to pathogen establishment and systemic movement. Tolerant/resistant cultivars such as Leccino and FS-17 show slower symptom progression and, in several studies, lower bacterial multiplication or more localized colonization through anatomical, physiological, transcriptomic, metabolic and microbiome-associated traits. Discussion: Detection has progressed from confirmatory PCR-based assays to integrated surveillance pipelines that combine risk-based sampling, high-throughput molecular tests, remote sensing, volatile organic compound profiling and epidemiological modelling. Management has shifted from emergency eradication in heavily infected zones toward context-specific integrated pest management based on vector suppression, certified plant material, tolerant/resistant germplasm, orchard hygiene, decision support and stakeholder engagement. Conclusion: Durable OQDS mitigation will require diversified tolerance and resistance sources, transparent surveillance, validation of microbiome- or plant-defense-based interventions, and coordinated policies that balance phytosanitary urgency with social and economic sustainability.