Seasonal hyperacute panuveitis
Seasonal hyperacute panuveitis 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 primarily 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]
Symptoms and signs
[edit ]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
[edit ]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]
Diagnosis
[edit ]![[icon]](https://en.wikipedia.org/wiki/File:Wiki_letter_w_cropped.svg){kind=link}
Treatment
[edit ]Antibiotic or steroid treatment usually bring little benefit. Some positive outcome has been observed with tempestive vitrectomy.[1]
Epidemiology
[edit ]Seasonality
[edit ]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]
References
[edit ]- 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.
- ↑ 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. 32 (2): 203–209. doi:10.1080/09273948.2022.2164512. PMID 36701769. S2CID 256304512.
- 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.
- 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.
- 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.
- ↑ 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.
- ↑ Upadhyay, Madan Prasad; Kharel Sitaula, Ranju; Manandhar, Anu; Gower, Emily W.; Karki, Pratap; Gurung, Haramaya; Maharjan, Indraman; Reuben, Samuel; 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.
- ↑ 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. 32 (7): 1400–1404. doi:10.1080/09273948.2023.2250440. PMID 37699175. S2CID 261703320.
- ↑ 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.