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Foul body odour during night. Any underlying disease?

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During the night when sleeping with my husband, I wake and roll over to cuddle him. He emits the most foul body odour and I can smell it under the sheets. It absolutely reeks and is an odour I really can't explain. He does not sweat during the night, so that is not the cause. I have told him about this, but as he does not smell it himself, he doesn't believe me. Could there be an underlying disease, as he is often not very well? He is 62.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
Mostly bad body odor can indicate -
Excessive sweating and bacterial growth on the skin, that leads to breakdown of the sweat into metabolites which emits the odor ( but you said he does not sweat, so let's look at other factors ).
The other some uncommon possibilities are : metabolic disorder but this will be mostly diagnosed by adult stage, as a side effect of some medications like anti depressants, e.t.c
What are his other symptoms? You said he is not keeping well? Does he have hypertension/diabetes ?
If he is on medications, what are the medicines that he takes?
Kindly give his complete medical history to give me some further insight on to his problems.
Also meanwhile you can get an anti-bacterial soap for him, and ask him to take bath. One more thing that can be done is application of Chlorhexidine solution 0.05 % on the sweat prone area before sleeping, once in the night time. Sometimes even in absence of a lot of sweat, skin may harbor a lot of bacteria leading to such foul smell. So this solution will help in reducing the bacterial content in the skin.
Awaiting your reply,
Regards.


Patient replied :

He is a heavy smoker and basically an alcoholic (the latter he does not agree with - just that he likes his "few" beers a day, which are often 12 cans, and hides Port in the house and sometimes consumes that before I arise from bed). We have had many arguments re his drinking and hiding what he consumes, but to no avail. He has been diagnosed with emphasemia (unsure how to spell), but still refuses to stop smoking. He takes Panadeine Forte daily, as he has pain in his back constantly. He is also losing weight rapidly. We married in 2002 and he was 78kg, He is now 54kg. Has had numerous blood tests, with the latest reading of his prostate being 6.5, with a further test early Dec. All other bloods have come back okay. It is unbeliebable, as I know there is something wrong. He has had 2 colonoscipies over the years too, and although a few polyps, and maybe precancerous signs, all good. Makes me wonder?? Please advise. The overnight body odour is a big concern, as I have to sleep with him.


Hello,
There are definitely certain health concerns as i can see from the detailed history.
Firstly 12 cans of beer if taken regularly over a period of time, can cause significant damage to the liver. Was his LFT done?
When was the last time you got all the blood tests done?
Emphysema is secondary to smoking, and he needs to be counselled to give up smoking.
Also did you mean to say his PSA is 6.5? Did you review this report with the urologist.
Can you also tell me where exactly the smell comes from? Is it more from his breath, or from his mouth?
Or the sweat prone areas such as axilla, or groin?
Without localising where exactly the smell is coming from, it will be difficult to come to a conclusion.
However i will advise that he applies the Chlorhexidine solution in his sweat prone areas, before sleeping for a week, and see if that causes some improvement. Mostly such patients who emit bad odor won't realise it themselves. Also he needs to use anti-bacterial soap for bathing everyday. Sometimes even without significant sweating, bacteria keeps growing in the skin and that emits a bad odor. That is possible in his case since he does not really have great immunity power, also because he has lost so much weight.
Kindly reply to the above mentioned questions and i will get back to you,
Regards.


Patient replied :

He had an LFT done about 2 years ago, and his liver reading was quite high. His then Dr ordered another blood test shortly after, and that one appeared to be much better. He was told to ease off his drinking which he did prior to the 2nd test. He sees a new Dr now and has regular blood tests. The Dr takes 3 or 4 vials of blood and I have no idea what he checks. His last one a few weeks ago showed his PSA for prostate as 6.5 so the Dr has ordered another in early Dec to compare. He doesn't see a urologist, only a local GP. The odour does not come from his face or arms, but appears to be from his torso area, what part I am unsure. It just exudes from under the bed covers and seems to be from his skin pores. I do not smell it any other time, i.e. during the day. I believe he does have low immunity, as his dramatic weight loss is of concern, and friends have commented on this. I am, however, the only person who knows about the nighttime body smell. I will buy some antibacterial soap and try your suggestion.


Hello,
Thank you for the detailed follow up.
There are some further concerns about his health. His PSA is 6.5, and that is possible either due to BPH, which can be ruled out with an ultrasound, or prostatitis, but in that case he will have other symptoms such as difficulty in urination, painful urination, e.t.c. The last possibility is Prostate CA, and it needs to be ruled out, better with a biopsy, since he has had so much weight loss.
Deranged liver values, and compromised liver can mean certain metabolites will not be absorbed properly and they will be converted into substrates called free radicals causing more damage to the organ.
Regarding that odor, i think with proper application of the soap and the Chlorhexidine solution, it will go. More so if it is coming from his pores, it definitely is due to bacterial activity.
Kindly try to schedule an urologist appointment and he can also guide you about the PSA.
Regards.


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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