Available online at www.sciencedirect.com Acta Tropica 106 (2008) 68–71 Short communication Herpes simplex labialis in children with acute falciparum malaria A. Sowunmi ∗ , G.O. Gbotosho, A.A. Adedeji, E. Tambo, O.M. Bolaji, C.T. Happi, B.A. Fateye Department of Pharmacology & Therapeutics and Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria Received 27 March 2006; received in revised form 1 February 2007; accepted 25 March 2007 Available online 31 January 2008 Keywords: Herpes simplex labialis; Children; Plasmodium falciparum Infection with herpes simplex virus type 1 (HSV-1) is com- mon globally (WHO, 1985; Smith and Robinson, 2002) and may manifest as symptomatic facial infections. Plasmodium falci- parum malaria is common in sub-Saharan African children and is a major cause of morbidity and mortality in these children (WHO, 2000). Therefore there is an increased chance that both infections may co-exist. Although malaria-associated morbidity may be relatively moderate or severe and that from herpes labi- alis (HL), one of the facial manifestations of HSV-1 infections, relatively trivial, it is unclear whether concomitant HL in chil- dren with acute malaria may aggravate the morbidity associated with both diseases. In addition, little is known of the prevalence of HL in children with malaria in sub-Saharan Africa. Knowl- edge of the possible interactions between the two diseases may help in improving the management of both. Falciparum malaria, particularly its severe form, may be asso- ciated with bacteraemia, septicaemia or viraemia (WHO, 2000; Berkley et al., 1999). Although fever and other factors are known triggers of recurrent HL, it is unclear whether malaria or the fever associated with it is an efficient trigger of HL. In the present study, the relationships between acute P. fal- ciparum and HSV-1 infections, manifesting clinically as HL have been evaluated. The main aims were to compare the point prevalence of HL in patients with malaria and com- mon cold, to evaluate if the concomitant presence of HL in patients with malaria is associated with significant increase in malaria-associated morbidity and to examine the time-course and response to antimalarial treatment of children with malaria ∗ Corresponding author at: Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria. Tel.: +234 2 2412101/2411904; fax: +234 2 2411843. E-mail addresses: malaria.iba@alpha.linkserve.com, akinsowunmi@hotmail.com (A. Sowunmi). and HL and those with malaria and no HL who are resident in an endemic area of southwest Nigeria. The children investigated presented at the malaria clinic of the University College Hospital in Ibadan-a hyperendemic area for malaria in southwestern Nigeria (Salako et al., 1990) between May and August 2005. The study was nested in an efficacy trial of combination antimalarials, ethical clearance for which was provided by the local ethics committee. Two hundred and twenty seven consecutive children aged <13 years presenting with fever and other symptoms suggestive of malaria or the common cold were enrolled in the study. The criteria for inclusion and other enrolment procedure were as earlier reported (Sowunmi et al., 2005). Briefly, a child was enrolled if infected with pure P. falciparum but no other Plasmodium spp., had >2000 asexual forms per microliter of blood, no evidence of severe malaria (WHO, 2000) and had the written informed consent of a parent or guardian. Patients with severe malnutrition, serious under- lying diseases (hepatic, cardiac, or renal) were excluded from the study. Children were considered to have common cold if they had at least any two of the following symptoms: fever in the 24 h preceding presentation, headache, cough, muscle ache, nasal drainage, nasal congestion, sneezing or sore throat and had a negative malaria smear. The diagnosis of recurrent HL was based on the par- ents/guardians of the children admitting there were orofacial ulcers that began as blisters during the course of the present- ing illness, and where possible, a past history of such ulcers, followed by a careful orofacial examination. The period of pro- drome in all the children was, clinically, indistinguishable from the symptoms of malaria. The details of procedure for clinical and parasitological examination has been described elsewhere (Sowunmi et al., 2005). Children with malaria and HL and those with malaria and no HL were treated with a combination of amodiaquine 0001-706X/$ – see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.actatropica.2007.03.005