Sporadic summer outbreak of SHAPU in even years: Does the pattern match with the usual autumn outbreak?

PURPOSE: Seasonal Hyperacute Panuveitis (SHAPU), is a mysterious blinding disease seen only in Nepal with a higher prevalence among children usually seen in autumn every alternate odd year since 1975. This report highlights the sporadic summer outbreak in the even years with atypical presentation. OBSERVATIONS: Three patients were diagnosed as SHAPU in the summer (May) of 2020. All of them noted the presence of white moths (Gazalina species) in their environment with or without direct physical contact. The clinical patterns were severe in nature including corneal melting. Two out of three patients (66.6%) developed phthisis bulbi and lost their vision. CONCLUSIONS AND IMPORTANCE: White moth has been associated as a risk factor for SHAPU. Despite the known natural history of appearance after monsoon of every odd year, the few unhatched eggs of the moths may hatch under the favorable circumstances in the summer of the even years and may lead to the sporadic outbreak of SHAPU. Though less in numbers, the clinical presentation of such sporadic SHAPU cases may be atypical with less favorable outcome.

Seasonal Hyperacute Panuveitis in Nepal: A Review over 40 Years of Surveillance.

Purpose: This review aims to provide a detailed update in Seasonal hypercute panuveitis (SHAPU) which is a blinding disease of unknown etiology reported only from Nepal, occurring every odd year since 1975 predominantly in children. Methods: Data sources were literature reviewed using PubMed, Medline, and ISI Databases (since 1975 to late 2017). Search items included SHAPU, seasonal endophthalmitis, hypopyon uveitis, caterpillar induced uveitis alone or in combination with white moth, panuveitis, and review. Results: Epidemics of SHAPU occur between August to December usually in odd years. Two thirds of the children present with unilateral blind eye which eventually becomes soft with shallowing of anterior chamber called as Malignant Hypotension. Hypopyon, fibrinous exudates in anterior chamber, difficult to dilate pupil and inability to visualize the retina because of massive exudation into vitreous producing a "White pupil in a Red eye" with little or no pain is its characteristic features. Contact with moths has been suspected. Because of presence of microbial agents in few cases, an infectious etiology has not been ruled out. Conclusions: Although SHAPU has been reported only from Nepal, lack of its report from ecologically similar terrain along Hindukush Mountains and possible association with moths remain intriguing.

New Clinical and Laboratory Findings of SHAPU.

INTRODUCTION: The cause of Seasonal hyperacute panuveitis (SHAPU) also known as seasonal endophthalmitis is not yet confirmed. So far, bacteria have been isolated from the vitreous of three cases, VZV from the aqueous of one case and anellovirus from the vitreous of 30 cases of SHAPU. Its connection with moth is still assumed but not proven yet. OBJECTIVE: To study the clinical and microbiological features of SHAPU. To find out indirect evidence of it connection with moths. METHOD: Prospective longitudinal study of all the cases of SHAPU observed at Tilganga Institute of Ophthalmology in 2009 and 2010. A detailed ocular examination was performed on each case and vitreous fluid was removed from almost all cases for microbiological study. RESULT: 66 cases of SHAPU were identified. Most were children. Twenty-three percent reported a recent history of white moth contact. Fine brown hairs, were present in 5 eyes. Bacteria were isolated from the vitreous of 9 eyes, PCR testing of the vitreous of all 48 cases showed no evidence of HSV, VZV or CMV DNA. Twenty of 34 cases (58.8%) who presented within 7 days of onset of symptoms had a final visual acuity ≥ 6/60 whereas 4/25 cases (16.0%) who presented after 7 days had final visual acuity ≥ 6/60 (p=0.001). CONCLUSION: Herpes group of virus is the less likely cause of SHAPU. Bacteria are found in more cases. Early presentation is associated with a better visual outcome. Role of moth in its pathogenesis is still suspected.

Seasonal Changes in Bird Species and Feeding Guilds along Elevational Gradients of the Central Himalayas, Nepal.

The Himalayas are a global hotspot for bird diversity with a large number of threatened species, but little is known about seasonal changes in bird communities along elevational gradients in this region. We studied the seasonality of bird diversity in six valleys of the Central Himalayas, Nepal. Using 318 plots with a 50 m radius, located from 2200 to 3800 m a.s.l., and repeated sampling during different seasons (mainly pre-monsoon, monsoon, and post-monsoon), we analyzed 3642 occurrences of 178 species. Birds classified in the literature as resident were more species-rich than migratory birds (140 vs. 38 species). In all six valleys and within the studied elevation range, species richness of all birds showed a peak at mid-elevation levels of 2600 or 3000 m a.s.l. Similar patterns were found for the most species-rich feeding guilds of insectivores (96 species) and omnivores (24 species), whereas the species richness of herbivores (37 species including frugivores) increased towards higher elevations. Among these feeding guilds, only species richness of insectivores showed pronounced seasonal changes with higher species numbers during post-monsoon season. Similarly, individual bird species showed distinct spatio-temporal distribution patterns, with transitions from species dominated by elevational differences to those characterized by strong seasonal changes. In an era of climate change, the results demonstrate that individual bird species as well as feeding guilds might greatly differ in their responses to climate warming and changes in the seasonality of the precipitation regime, two aspects of climate change which should not be analyzed independently.