Shapu in nepal

A seminar presentation on
SHAPU in Nepal
Presented by
Sabita Mahat
Roll no: 24
BPH,8th semester
Pokhara University
7/7/2019 1SHAPU in Nepal

Outline of presentation
S.N Headings
1 Introduction
2 Statement of problem
3 Objectives
4 Methodology
5 Findings
6 Conclusion
7 References

INTRODUCTION
Seasonal Hyperacute Panuveitis (SHAPU) is a unique, most rapidly
destructive intra-ocular inflammatory disease.
The disease is almost always unilateral with rapid and profound
loss of vision.
It occurs in two year cycles in odd years since 1975 predominantly
in children.
Two-thirds of the victim are children and untreated eyes become
blind and soft within a week.
It has been reported mostly between 9 months to 50 years of age.

• It occurs in epidemic form beginning with end of monsoon ( August –
September) and usually ending with beginning of severe winter in December-
January usually in odd years.
• Starting as a red-eye and leukocoria accompanied by little or no pain this
quickly turns into something more frightening within days.
• There is condition of hypopyon. This is followed by hypotony and a very
sudden drop in vision.

• Non-infective severe ocular inflammation presenting as a white pupil in
the red eye with rapid loss of vision which previously named as Seasonal
Endophthalmitis is named as SHAPU( Seasonal Hyperacute Panuveitis)
in the year 1979.
• Most of the eyes even after treatment end up in phthisis
bulbi.

Statement of Problem
• SHAPU affects mostly the children. It is also prevalent among
pediatric population.
• About 87% of the cases reported were children under 16 years of
age in the study done by Upadhyaya. Two thirds of affected
children present with a blind eye and the rest lose vision rapidly.
• Several experiments also couldn’t find out the etiology of this
disease.
• The most common cause of panuveitis among pediatric patients in
Nepal is reported to be SHAPU (27,7%)..

OBJECTIVE
General objective
To review arrival literatures about the prevalence of SHAPU in
Nepal.
Specific Objectives
To know about the etiology and clinical features of SHAPU.
To know the cases of SHAPU in Nepal.
To know about the treatment and prevention methods of SHAPU.

METHODOLOGY
7/7/2019 87/7/2019 8
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SHAPU in Nepal, Endophthalmitis
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FINDINGS
(Objective 1)
Etiology
• The etiology of this disease remains unknown.
• No virus or antigen has been demonstrated by
serological and immunological tests.
• White moth remains to be an important link to lead to
causation of SHAPU but does the moth cause the
disease by direct injection of toxins or act as vector in
transmission of infecting agents or antigens is still
unknown..

Clinical Features
Symptoms
• Sudden onset of redness with minimal pain
• White pupillary reflex (leukocoria) in a red eye
• Decreased vision
• Unilateral involvement
• Eyes become pthisical

Clinical Features contd.
Signs
• Leukocoria
• Fibrinoid anterior chamber reaction
• Hypopyon
• Shallow Anterior chamber
• Collection of fibrinoid exudates in the crypts of muddy iris
• Decreased intraocular pressure (malignant hypotension)

A typical case of SHAPU- A child presenting of unilateral nonpainful red
eye with white pupil

SHAPU patients presenting with similar clinical features

Cases of SHAPU reported
(Objective 2)
In 1975 , the first case of severe inflammatory eye disease presenting
as a white pupil in a red eye with rapid loss of vision was reported.
Similar cases appeared again after two years in 1977 with identical
presentation and outcome. Both out breaks began during September
and lasted until about January- the next year.
In December 1978, a series of 13 cases as epidemic of blinding eye
disease probably caused by Tossock Moth was reported for the first
time in Pokhara.

In the total of 13 cases, 7 were female and 6 were male with ages
ranging from 3 months to 39 years.
Of this 9 were below 10 years of age. In all of them only one eye
was involved and all eyes went blind in a week or so in spite of the
earliest and intensive treatment with topical and sub tenons steroids.
Two patients gave definite history of contact with moths.

No cases were seen during 2000 and again cases were seen during Aug-
Sept 2001.
Six cases ( aged 3 to 16 years) of hyperacute endophthalmitis consistent
with SHAPU seen at Tilanga Eye Center in the autumn of 2005.
SHAPU hit the country in the year 2015. Earlier, nearly 50 people,
including children, were infected with SHAPU .

In 2017 ,a 46-day old infant, Rojan Sunar of Miyapatan, Pokhara, got
infected by SHAPU. Raj Kumar Sunar, the father of the baby informed
Rojan suffered from allergy after a moth landed on his cheeks.
On the second day, the child’s eyes turned red and began to swell.
They took the baby to Pokhara Eye Hospital for treatment but doctors at
the hospital referred the child to BP Koirala Hospital for immediate
operation.

Youngest reported SHAPU Case
• A case from Pokhara of a 38 days healthy
male baby noticed with redness in child’s
right eye for 5 days(October 2017).
• The parents had noticed the fall of white moth
from the tube light over the child face 1 day
prior to symptom onset.
• Next morning the right eye developed redness
and swelling. After 3 days whitish pupillary
reflex was noted and child was irritable and
brought to the eye hospital.

• Upon diagnosis, it was found that the
red eye was congested with dense
anterior chamber reaction and white
pupillary reflex.
• The child was maintained on topical
antibiotics and corticosteroids eye
drops.
• Vitrectomy was done and follow up was
done.
• Now the child is stable with no
occurrence till date.

• Among the 10 recent cases, two children have low vision even after
operation, while others have their vision intact.

General Treatment and prevention
(Objective 3)
Surgery
Timely and early vitrectomy, the surgical operation of removing the
vitreous humour from the eyeball, is a useful procedure for the
treatment of SHAPU.
The surgical operation helps restore the patients’ vision fully or
partially.
Medical Therapy
For any suspicious case of SHAPU topical antibiotics Tobramycin can
be started 4 hourly in affected eye.

Prevention
Keep the home environment clean and
green.
Use bed net while sleeping.
Keep the children out of reach of moths.
Eat vitamin A enriched fruits and
vegetables.
Wash the eye timely.
Sought out for doctor as soon as possible.

CONCLUSION
• SHAPU continues be to most devastating inflammatory eye disease
rendering eye functionless within a week.
• SHAPU can affect even the eye of the infant. White moth remains a strong
risk for its etiology.
• There is high prevalence of SHAPU in children specially of Pokhara
valley.

RFERENCES
• Malla OK, “Endophthalmitis Probably Caused By Tussock Moth”. In
Report of the Proceedings of the first National Seminar on
Prevention of Blindness, 1978, p. 44.
Upadhayay MP et al., Seasonal Hyper Acute Panuveitis of unknown
etiology. Ann. Ophthalmol. 1984;16:38-44.
• Children below age of 10 at high risk of SHAPU infection.The Himalayan
Times.2017
• Upadhyay PM, Shrestha B.SHAPU:Forty years on mystery
persists.2017;9(17): 13-6.
• Khatri A, Kharel R, Upadhyay MP, Karki P. Enigma of Seasonal
Hyperacute Panuveitis (SHAPU) - A report from Nepal.2017.
• A Manandhar, G Paudel, CK Rai, SK Rai, R Gurung, S Ruit.
Seasonal hyper acute pan uveitis - recent scenario in
Nepal.2008;10(3):198-1987/7/2019 24SHAPU in Nepal

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Shapu in nepal

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