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]


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]


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]


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]


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


  1. ^ a b c 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. ^ a b c d 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. ^ a b c d e 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. ^ a b c 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.