HALITOSIS AS AN ADDITIONAL CLINICAL MARKER OF STREPTOCOCCAL TONSILLITIS IN CHILDREN: OUTPATIENT OBSERVATION
DOI:
https://doi.org/10.11603/24116-4944.2025.2.15820Keywords:
halitosis, streptococcal tonsillitis, pediatric diagnosis, group A β-hemolytic streptococcus (GABHS), oral malodor, chronic tonsillitis, rapid antigen test, bacterial pharyngitis, outpatient pediatrics, diagnostic markersAbstract
The aim of the study – to evaluate the clinical significance of halitosis as a supplementary marker of streptococcal tonsillitis in children aged 3–18, including its correlation with confirmed Group A β-hemolytic streptococcal (GABHS) infection.
Materials and Methods. A total of 279 children presenting with symptoms of acute or chronic tonsillopharyngitis were assessed between January and May 2025. Clinical examination included halitosis evaluation and a rapid antigen test for GABHS. Patients with non-streptococcal or unrelated conditions were excluded.
Results and Discussion. Of 190 children with confirmed streptococcal infection, halitosis was observed in 128 (67.4 %). The symptom was most prevalent in follicular (89.3 %) and lacunar (78.5 %) tonsillitis and during exacerbations of chronic tonsillitis (81 %). Younger children (7–10 years) exhibited the highest prevalence (73.2 %). Halitosis intensity was moderate in 50.8 % and severe in 27.3 % of cases. A strong correlation was found between halitosis and positive rapid streptococcal test results (87.5 % of halitosis cases were GABHS-positive), versus 36 % among viral cases.
Conclusions. Halitosis may be a valuable, easily detectable marker for streptococcal pharyngotonsillitis in children, especially in settings with limited diagnostic tools. Its integration into clinical algorithms could improve early identification of bacterial infections and guide antibiotic prescribing, supporting efforts to reduce antibiotic resistance.
References
1. Yoo, H.J., Jwa, S.K., Kim, D.H., & Ji, Y.J. (2020). Inhibitory effect of Streptococcus salivarius K12 and M18 on halitosis in vitro. Clinical and Experimental Dental Research, 6(2), 207–214. https://doi.org/10.1002/cre2.269.
2. Sikorska-Żuk, M., & Bochnia, M. (2018). Halitosis in children with adenoid hypertrophy. Journal of Breath Research, 12(2), 026011. https://doi.org/10.1088/1752-7163/aa9b3a
3. Bawazir, O.A. (2021). Risk factors, diagnosis, and management of halitosis in children: A comprehensive review. The Journal of Contemporary Dental Practice, 22(8), 959–963.
4. Smith, K.L., Hughes, R., & Myrex, P. (2023). Tonsillitis and tonsilloliths: Diagnosis and management. American Family Physician, 107(1), 35–41.
5. Brant Pinheiro, S.V., de Freitas, V.B., de Castro, G.V., Rufino Madeiro, B.C., de Araújo, S.A., Silva Ribeiro, T.F., & Simões e Silva, A.C. (2022). Acute post-streptococcal glomerulonephritis in children: A comprehensive review. Current Medicinal Chemistry, 29(34), 5543–5559 https://doi.org/10.2174/0929867329666220613103316.
6. Sika-Paotonu, D., Beaton, A., Raghu, A., ... & Fischetti, V.A. (2017). Acute rheumatic fever and rheumatic heart disease. In J.J. Ferretti, D.L. Stevens, & V.A. Fischetti (Eds.), Streptococcus pyogenes: Basic Biology to Clinical Manifestations. University of Oklahoma Health Sciences Center.
7. Gokdogan, O., Catli, T., & Ileri, F. (2015). Halitosis in otorhinolaryngology practice. Iranian Journal of Otorhinolaryngology, 27(79), 145–153.
8. Tungare, S., Zafar, N., & Paranjpe, A.G. (2025). Halitosis. In StatPearls. StatPearls Publishing.
9. Aylıkcı, B.U., & Colak, H. (2013). Halitosis: From diagnosis to management. Journal of Natural Science, Biology and Medicine, 4(1), 14–23. https://doi.org/10.4103/0976-9668.107255.
10. Bondarenko, Y., & Birjukova, M. (2025). Etiopathogenetic mechanisms of recurrent tonsillitis development in children in organized groups. Grail of Science, 49, 1109–1119. https://doi.org/10.36074/grail-of-science.21.02.2025.158.
11. Bondarenko, Y., Zhuravel, Y., & Ognev, V. (2025). Determinants of health in preschool and school-age children: Challenges of recurrent tonsillitis. Grail of Science, 49, 1089–1100. https://doi.org/10.36074/grail-of-science.21.02.2025.157.
12. Yaegaki, K., & Sanada, K. (1992). Biochemical and clinical factors influencing oral malodor in periodontal patients. Journal of Periodontology, 63(9), 783–789. https://doi.org/10.1902/jop.1992.63.9.783.
13. Bondarenko, Y., & Biriukova, M. (2025). Clinical and diagnostic significance of the color and consistency of discharge from the upper and lower respiratory tracts in assessing the bacterial or viral etiology of disease. Young Scientist, 2(133), 25–31. https://doi.org/10.32839/2304-5809/2025-2-133-33.
14. Guntinas-Lichius, O., Geißler, K., Mäkitie, A.A., Ronen, O., Bradley, P.J., Rinaldo, A., ... & Ferlito, A. (2023). Treatment of recurrent acute tonsillitis: A systematic review and clinical practice recommendations. Frontiers in Surgery, 10, 1221932. https://doi.org/10.3389/fsurg.2023.1221932.
15. Sharma, K., Das, S., & Goswami, A. (2022). A study on acute membranous tonsillitis, its different etiologies and its clinical presentation in a tertiary referral centre. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl. 3), 4543–4548. https://doi.org/10.1007/s12070-021-02572-2.
16. Sidell, D., & Shapiro, N.L. (2012). Acute tonsillitis. Infectious Disorders – Drug Targets, 12(4), 271–276. https://doi.org/10.2174/187152612801319230.
17. Windfuhr, J.P., Toepfner, N., Steffen, G., Waldfahrer, F., & Berner, R. (2016). Clinical practice guideline: Tonsillitis I. Diagnostics and nonsurgical management. European Archives of Oto-Rhino-Laryngology, 273(4), 973–987. https://doi.org/10.1007/s00405-015-3872-6.
18. Bird, J.H., Biggs, T.C., & King, E.V. (2014). Controversies in the management of acute tonsillitis: An evidence-based review. Clinical Otolaryngology, 39(6), 368–374. https://doi.org/10.1111/coa.12299.
19. Abu Bakar, M., McKimm, J., Haque, S.Z., Majumder, M.A.A., & Haque, M. (2018). Chronic tonsillitis and biofilms: A brief overview of treatment modalities. Journal of Inflammation Research, 11, 329–337. https://doi.org/10.2147/JIR.S162486.
20. Alrayah, M. (2023). The prevalence and management of chronic tonsillitis: Experience from secondary care hospitals in Rabak City, Sudan. Cureus, 15(2), e34914. https://doi.org/10.7759/cureus.34914.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Я. Д. Бондаренко, Н. О. Шушляпіна
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
