Seasonal hyperacute panuveitis

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Seasonal hyperacute panuveitis (SHAPU) is an aggressive eye disease of unknown etiology, first described in 1975. [1] It has been recorded almost exclusively from Nepal, with the exception of five cases reported from Bhutan. [2] The disease affects prevalently children and can cause blindness. [3] In Nepal, it is the most common reported cause of panuveitis, and in children it is the most prevalent cause of both uveitis and panuveitis. [4]

Contents

Symptoms

The disease almost always affects only one eye. The first sign is usually a painless reddening of the affected eye. [5] Whitening of the pupil, due to massive exhudation into the vitreous, is typical, leading to the hallmark "white pupil in a red eye". [1] Visual loss is rapid, taking hours or, at most, few days – two-thirds of the patients are already blind in the affected eye when presenting. [5] Intraocular pressure plummets, eventually causing phthisis bulbi. [4]

Causes

The cause of seasonal hyperacute panuveitis is unknown. Several bacteria and viruses, such as anelloviruses, have been tentatively associated with the disease. [4] [6] The only known risk factor seems to be contact with an unidentified species of white moths, possibly of the genus Gazalina , known to swarm at the end of the monsoon season. [3] [7] [8] Moth hairs have been identified in the eyes affected by the disease; [4] [9] however, in 2023 several cases were reported with no signs of association with the Gazalina moths. [3]

Seasonality

The disease occurs mostly after the monsoon season, between September and January. Prevalence peaks every two years. [3] [4] The causes of the seasonal and biannual patterns are unknown. Almost all cases originate in the subtropical, temperate, and subalpine regions of Nepal. [5]

Treatment

Antibiotic or steroid treatment usually bring little benefit. Some positive outcome has been observed with tempestive vitrectomy. [1]

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References

  1. 1 2 3 Shrestha, Bharat R.; Upadhyay, Madan P. (2017). "SHAPU: Forty years on Mystery Persists". Nepalese Journal of Ophthalmology. 9 (18): 13–16. doi: 10.3126/nepjoph.v9i1.17527 . PMID   29022949.
  2. ↑ Tamang, Sandip; Jayanna, Sushma; Tshering, Sonam Choden; Zangmo, Ugyen; Powdyel, Adwitya; Dorji, Phuntsho; Kezang, Dechen; Gurung, Kunti Devi; Dukpa, Mendu; Wangdi, Lhacha; Wangmo, Karma Yeshey; Wangmo, Dechen; Deki; Lepcha, Nor Tshering; Getshen, Kunzang; Das, Taraprasad (2023). "Seasonal Hyperacute Panuveitis (SHAPU) in Bhutan". Ocular Immunology and Inflammation: 1–7. doi:10.1080/09273948.2022.2164512. PMID   36701769. S2CID   256304512.
  3. 1 2 3 4 Bolakhe, Saugat (2023). "Are these moths blinding children? Nepalese researchers seek answers". Nature. doi:10.1038/d41586-023-03414-7. PMID   37923949. S2CID   265012955.
  4. 1 2 3 4 5 Karn, Mitesh; Gurung, Jamuna (2022). "Outbreak of seasonal hyperacute panuveitis disease in Nepal". The Lancet Global Health. 10 (1): e39–e40. doi: 10.1016/S2214-109X(21)00513-1 . PMID   34919853. S2CID   245195527.
  5. 1 2 3 Upadhyay, Madan; Kharel Sitaula, Ranju; Shrestha, Bharat; Khanal, Bhaiya; Upadhyay, Bishnu Psd; Sherchand, Jeevan B.; Ghimire, Prakash (2019). "Seasonal Hyperacute Panuveitis in Nepal: A Review over 40 Years of Surveillance". Ocular Immunology and Inflammation. 27 (5): 709–717. doi:10.1080/09273948.2018.1439643. PMID   29543556. S2CID   3924545.
  6. ↑ Smits, Saskia L.; Manandhar, Anu; Van Loenen, Freek B.; Van Leeuwen, Marije; Baarsma, G. Seerp; Dorrestijn, Netty; Osterhaus, Albert D. M. E.; Margolis, Todd P.; Verjans, Georges M. G. M. (2012). "High Prevalence of Anelloviruses in Vitreous Fluid of Children with Seasonal Hyperacute Panuveitis". The Journal of Infectious Diseases. 205 (12): 1877–1884. doi:10.1093/infdis/jis284. PMC   7107317 . PMID   22492851.
  7. ↑ Upadhyay, Madan Prasad; Kharel Sitaula, Ranju; Manandhar, Anu; Gower, Emily W.; Karki, Pratap; Gurung, Haramaya; Maharjan, Indraman; Reuben, Sameul; Karmacharya, Biraj Man; Joshi, Sagun Narayan (2021). "The Risk Factors of Seasonal Hyperacute Panuveitis". Ophthalmic Epidemiology. 28 (3): 250–257. doi:10.1080/09286586.2020.1820533. PMID   32981405. S2CID   222167311.
  8. ↑ Gurung, Haramaya; Kharel Sitaula, Ranju; Karki, Pratap; Lamichhane, Gyanendra; Singh, Sweta; Shrestha, Eliya; Khatri, Anadi; Banstola, Amrit; Joshi, Pursottam; Dahal, Hira Nath; Sharma, Ananda K.; Joshi, Sagun Narayan; Prasad Upadhaya, Madan (2023). "Seasonal Hyperacute Panuveitis (SHAPU) Outbreak Amidst COVID-19 Pandemic". Ocular Immunology and Inflammation: 1–5. doi:10.1080/09273948.2023.2250440. PMID   37699175. S2CID   261703320.
  9. ↑ Kharel (Sitaula), Ranju; Karki, Pratap; Joshi, Sagunn; Sharma, Anandak; Upadhyay, Madanp (2020). "Moth hair in cornea in a case of seasonal hyperacute panuveitis". Indian Journal of Ophthalmology. 68 (5): 930–932. doi: 10.4103/ijo.IJO_995_19 . PMC   7350494 . PMID   32317495.
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