This case study describes 49-year-old Mr. Dhatchanamoorthy who presented with fever, cough, vomiting and breathlessness. He was diagnosed with pulmonary tuberculosis and a history of diabetes. He lives in a nuclear family in a rural village in a house with adequate ventilation and sanitation. Medical examination found him moderately nourished with signs of left lung consolidation. Sputum examination confirmed active tuberculosis bacteria. He was started on antitubercular treatment and advised on nutrition, hygiene and follow-up to support his recovery.

1. CLINICO- PSYCHO- SOCIAL
CASE STUDY
TUBERCULOSIS
GROUP 4,5 & 6

2. Patient profile
● Name: Dhatchanamoorthy
● Age: 49
● Gender: Male
● Religion: Hindu
● Education:7th std
● Address: Keezhpettai,ECR,villupuram.
● Occupation: social worker in taluk office.

3. Health care facility
Nearest health care facility: Anumandhai GH, 5 minutes on walking.
Preferred health care facility: Marakkanam GH.
Reason for preference: nearby working place
Nearby DOTS centre: he doesn’t know

4. Family profile
Type of family : nuclear family
S.no Name Relation
to head
Age / sex Occupati
on
income illness
01 Dhatchanamoorthy Head 49/male Social
worker
5000 TB
DM
02 Jayalakshmi Wife 40/female House
wife
- -
03 Keerthana Daughter 24/male Company
worker
5000 -
04 Gurumoorthy Son 17/male Student - -

5. Socio economic status
Colour of the ration card : red
Total income of family:10,000
No.of earning members :2
Per capita income : 2500
Socioeconomic class:class lll( according to modified BG Prasad scale)
No debts/ loans
No health insurance taken

6. Chief complaints
•Fever X 1 week
•Cough with expectoration X 2 days
•Vomiting X 2 days

7. History of Presenting illness
•The patient was apparently asymptomatic 15 days back after which he
developed fever, which was sudden in onset, intermittent in nature, diurnal
variations seen with evening rise of temperature, associated with chills, lasting
for a period of 1 week and relieved on taking medications.
•The patient also had complaints of cough with expectoration , exaggerated
during the past 10 days, which was insidious in onset, progressive in nature,
relieved on taking medications, with no diurnal and postural variations and was
associated with sputum production, which was scanty, mucoid in consistency ,
non- foul smelling and not blood stained.
•H/O vomiting, 4 episodes/day for 2 days, containing food particles and not
blood-stained.
•H/O body ache,running nose

8. •H/o Breathlessness, present even while walking for a short distance
(Grade 3 according to mMRC grading)
•H/o weight loss (2kg) , loss of appetite.
•H/o loss of smell and taste sensations
•No H/o night sweats, sore throat, diarrhoea
•No H/o dizziness, chest pain, palpitations, syncope, pedal edema
•No H/o back pain, joint pain ,bone deformity, joint rigidity.
•No H/o headache,neck stiffness,convulsions.
•No H/o abdominal distension, constipation,abdominal pain.
•No H/o swellings, discharging sinuses.
•No H/o infertility, oliguria,facial edema, skin lesions,oral thrush

10. Course of illness
The patient came to hospital with complaints of fever (1 week), cough
with expectoration (2 days), vomiting (2 days), was admitted and was
treated as a case of AFI after taking necessary investigation
21/09
23/09 Throat swab and Chest X-ray was taken to rule out covid infection
Found to be Covid Negative and Chest X-ray showed consolidation of
Left upper lobe of lungs - diagnosed as bronchiectasis with secondary
infection
25/09

11. 27/09
28/09 2nd early morning sputum sample was collected
1st sputum sample was collected for microscopic examination and
culture and sensitivity
29/09
Microscopy (ZN) showed presence of AFB (+3)
HIV testing was negative for HIV antibodies
HbsAg and anti HCV are negative
Culture report of sputum showed presence of Klebsiella pneumonia and
drug sensitivity report showed sensitive to amikacin and cotrimoxazole
and resistant to ceftriaxone

14. 30/09
•Newly diagnosed Pulmonary Tuberculosis with Left upper lobe
consolidation
The case was registered and ATT was started on the same day

15. Treatment History
FOR TUBERCULOSIS
Phase of treatment - Intensive phase
Fixed dose combination of 4 drugs - ISONIAZIDE, RIFAMPICIN,
PYRAZINAMIDE, ETHAMBUTOL was given
5 pills per day
Adverse effects - severe vomiting, gastric irritation , orange discoloration
of urine
FOR DIABETES
METFORMIN 500mg BD

16. Past History
● No h/o similar complaints in the past.
● K/C/O Diabetes for 2 years on regular medication.
● 1st dose of covid vaccine taken
● No h/o Hypertension, Asthma, Seizures
● No h/o HIV
● No h/o previous hospitalization, blood transfusion or surgeries.

17. Personal History
● Inadequate sleep owing to illness
● H/O loss of appetite.
● Normal bowel and bladder habits.
● No h/o addictions
● No h/o allergy to any drug or food.

18. Occupation History
● Currently he is not working due to his illness.
● Previously worked as social worker

19. Contact History
● No previous history of contact with tuberculosis patients.
● H/o travelling to distant places and consumption of outside food.

20. Nutritional History
● Mixed diet( Non veg consumed 2 days a week)
● No diet modification practiced for diabetes
● No practice of fasting
● No H/O skipping meals
● Total salt intake: 1kg (Tata salt) per month
● Per capita salt intake: 8.33g/ person/day
● Total oil consumption: 2L( Refined sunflower oil)
● Per capita oil intake: 16.6ml/ person/ day

21. Quantitative ( 24hr Recall method)
Timing Food Consumed Calorie Protein
Morning 4Idli
sambar( 1cup)
300kcal
66kcal
10g
4g
Afternoon Rice and sambar
Rasam
Kootu
181kcal
30kcal
145kcal
6.56g
1.5g
5g
Evening Tea 75kcal 3g
Dinner Rice
Rasam
Poridge
115kcal
30kcal
220kcal
2.56g
1.5g
4.5g

22. OBSERVED RECOMMENDED COMMENT
CALORIE 1162 Kcal 2427.6Kcal 1265 Kcal deficit
PROTEIN 38.62g 81g/day 42.38g deficit

23. Family History
● It is a nuclear family consisting of 4 members.
● No h/o similar complaints in the family.
● No h/o any chronic illness in the family.

24. Psychosocial History
● He is worried about his illness.
● He worries about not going to job and loss of income.
● Has a cordial relationship within family

25. Environmental history
Housing
● It is pucca type of house with 3 living rooms and no overcrowding.
● Adequate ventilation and lighting is present.
● Separate kitchen is present ,with smoke outlet and no indoor air
pollution
● Fuel used is LPG
● Household latrine is present.

26. Water supply
● Household tap water (3 times / day), purification is by boiling, stored
in closed vessels.
Waste disposal
● Dustbin is present, and waste collected daily by the municipality.
● sputum disposal - spits sputum indiscriminately

27. Knowledge , Attitude , Practice
Knowledge Attitude Practice
The patient is not aware of
‘what TB is’
He is cooperative for the
investigation and treatment
Spit around indiscriminately
Not aware of the symptoms
of TB
Not follows cough etiquette
Not aware of TB is a
communicable disease
Takes medications regularly
Not aware that treatment for
TB is free
Believes that he will be cured
at the end of treatment
Wears mask while talking to
other people
Not aware of ‘where to get
drugs for TB’

28. General examination
● Patient was conscious, cooperative, well oriented to time, place and
person.
● Well built and well nourished.
● No pallor, icterus, clubbing, cyanosis, lymphadenopathy and edema.

29. Vitals
● Temperature : Afebrile
● Pulse rate : 86 beats / min
● Respiratory rate : 22 breaths/ min
● Blood pressure : 118/76 mmHg

30. Anthropometry
● Height : 170 cms
● Weight : 65 kg
● BMI : 22.49 kg/ sq.m (normal according to Asian classification)
● Waist hip ratio = 97:100 = 0.97
● BCG scar present on left upper arm

31. Respiratory system examination
Inspection
Chest
● Shape : Bilaterally symmetrical
● Respiratory movement. : Abdomino- thoracic
● Position of trachea : Central
● Apical impulse : Not seen
● Kyphosis ,Scoliosis : Absent
● No scars or dilated veins are seen.
● No drooping of shoulder
● No visible pulsations, rib crowding
Systemic examination

32. Palpation
● Warmth & Tenderness. : present and non-tender
● Position of trachea. : Central
● Chest wall movements. : Equal on both sides
● Chest expansion. : Inspiration (95 cms.) & Expiration (99 cms.)
● Apex beat : Felt in left 5th intercostal space ½ inch medial
to the midclavicular line
● Vocal fremitus : Increased.
● Lymph nodes : No significant lymphadenopathy
● Chest circumference. : Both half are equal in size

33. Percussion
Areas Right Left
Supraclavicular Resonant Dullness
Infraclavicular Resonant Dullness
Mammary Resonant Dullness
Inframammary Resonant Dullness
Axillary Resonant Resonant
Infraaxillary Resonant Resonant
Suprascapular Resonant Resonant
Interscapular Resonant Resonant
Infrascapular Resonant Resonant

34. Auscultation
● All nine areas were auscultated – vocal resonance increased in left
supraclavicular, infraclavicular ,mammary regions. Other sites heard
normal.
● Bronchial breath sounds present.
● Crackles are heard.

35. CVS examination
S1 & S2 heard normally, no murmurs.
No engorged veins or scars & sinuses
Abdomen examination
Soft, not distended, no tenderness, no organomegaly
CNS examination
Alert, no focal neurological deficit, no loss of consciousness

36. Clinical diagnosis
Mr Dhatchanamoorthy ,49 year old male was diagnosed
microbiologically as a New case of Pulmonary Tuberculosis with no
other complications and was a known case of diabetes for 2 years and is
currently on antitubercular treatment (ATT - Intensive phase day 2).

37. Family Diagnosis
This is the family of Mr. Datchanamoorthy which is a Nuclear Family consisting of
4 members with an eligible couple, no geriatric,and no Under 5 child living in own
pucca house with adequate ventilation and no overcrowding,residing in
Keezhapettai,ECR,villupuram,coming under Class lll socioeconomic status
(according to Modified BG Prasad scale),has a good environmental
surrounding.No other co-morbidities among his family.

38. Risk Factors
Agent Factors:
Source of Infection : H/O travelling to distant places(Social worker) may
increase the chance of exposure( human strain).
Host Factors:
Gender : Male ( TB is more prevalent in males)
Nutrition : No Malnutrition
Immunity: No past infection
Social Factors:
Lack of awareness about the disease and awareness of cause of illness.

39. Management
AT INDIVIDUAL LEVEL:
● Advised to follow proper personal hygiene , cough etiquette and sputum
disposal(using 5% Phenol)
● Advised to take nutritious food ( Protein rich foods ) and consume more
fruits and vegetables
● Advised to seek medical attention incase of any complications
● Advised regular follow up
● Advised not to skip medications

40. AT FAMILY LEVEL:
● Educate the family about the condition of the patient
● Emotional support from family during recovery
● Advised them not to stigmatise the patient
● Screening for Tuberculosis if symptoms present
● Covid vaccination

41. AT COMMUNITY LEVEL:
Avail Govt. schemes and services ( NTEP ,Nikshay Poshan
Abhiyan –DBT, PDS, ICDS, Antyodaya Anna Yojana &AWWs,
ASHAs, and TB Health Visitors (TB care groups) counselling
support, monitoring treatment adherence)
Awareness about the disease, transmission and Prevention

42. THANK YOU