Tuesday, August 19, 2008

You stink!

Another day in the life with kids:

Ooooh that smell
Can't you smell that smell
Ooooh that smell
The smell of strep surrounds you
(apologies to Lynrd Skynrd)
A few days ago Youngest spent some time with a family friend, returning home several hours sooner than expected. Coming in the door, he complained of a headache. Our friend explained that Youngest hadn’t seemed quite his perky self during their outing, adding he was surprised when Youngest abruptly asked to return home.

I put an arm around Youngest and he leaned in for a hug. I was initially repulsed at how warm he was – but shrugged it off to the heat of the day and the time he had spent outside. But what did I just smell? Only a quick whiff, gone before I could really say with certainty I had recognized it. Nonetheless, after our friend left, I put Youngest on the sofa and got the thermometer. 101.3 – not a typical temperature after spending time outside, no matter how hot it gets. Ergh. Let’s keep a close eye on this, I thought.
“How’s your head, bud?”
“It’s OK, Mom.”
“Any sore throat?”
“Uh uh.”

Maybe I was mistaken about that smell…

The next morning, Youngest was still febrile. Leaning close, the smell was unmistakable.
“How’s your throat today?”
“It hurts when I swallow, Mom.”
*Sigh*
“Open up. I want to look at your throat.”
“AAAHH” Youngest has an amazing ability to open his mouth when he wants to be cooperative. I was able to see almost down to his larynx, so I had no problems identifying the pustules along his tonsils. As he exhaled, the scent was overpowering. Strep. Unmistakable. I could have waved a rapid strep screen in front of his face and obtained a postive response.

“OK, time for some medicine for you.”
I knew he was really sick when he responded with “Can I have the pills instead of the yucky liquid?” instead of his usual protests against any type of medication.

So now we’ve been on antibiotics for 48 hours. The pustules are going away. Youngest is back to his usual bouncy self. And I’m hovering around Eldest on a regular basis, waiting for him to exhale, waiting for him to develop that smell.

A

photo from Medscape.com

6 comments:

  1. My mom swore she could smell strep on us too! Yet when I asked our wise old outpatient pediatrics preceptor about it the other day, he looked at me funny and said that no, there was no particular odor associated with strep. He did kind of roll his eyes and mention that *some moms* say they can smell it on their kids, and that maybe they have very excellent noses. I think my mom would agree with you though - she says it's a smell she can hardly be in the same room with.

    Interesting that you'd post about this. :)

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  2. I don't know anything about being able to smell strep, but I always know the "feel" of strep when I have it. It feels like swallowing razor blades. Nothing else feels like strep, and I "know" that's what it is, and I am always right.

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  3. Sara, there is a definite smell to strep. I've had nurses over the years who could diagnose strep just by smelling a kid's breath. Sometimes a kid will smell when they have other things going on - like mono or hand, foot, mouth but it's different than the strep smell. It's a pity doctors discount parent's intuition about their kids.

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  4. Just reading this post, I can smell it. Ewwww.

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  5. Sara, perhaps I'm showing my age, or maybe your preceptor didn't spend as much time in the microbiology lab as I did, but "back in the day" when we had to wait for strep to grow out there were many friendly microbiologists who would share the results of cultures before the official reading time; during one such excursion to the lab for results, one woman took the time to show me how a specimen was plated and how the lab could isolate the suspected pathogens - and then gave me my first whiff of a fully "ripe" culture. Much like ketoacidosis or melena, it's a smell you can't forget. In this day of rapid strep screens, I'm not sure if cultures are ever sent out anymore. If they still are, it might be worth a field trip to your local lab to find out if they have any strep growing (you know, in your spare time :) )

    Best, A

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  6. our first family doc one time on the phone asked me, after my kids had had strep a few times to smell their breath to see if I thought it was strep or not.

    Strep definitely has a distinctive smell.

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