Shapu in nepal

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.

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

2. Outline of presentation S.N Headings 1 Introduction 2 Statement of problem 3 Objectives 4 Methodology 5 Findings 6 Conclusion 7 References 7/7/2019 2 SHAPU in Nepal

3. 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. 7/7/2019 3 SHAPU in Nepal

4.  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. 7/7/2019 4 SHAPU in Nepal

5. 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. 7/7/2019 5 SHAPU in Nepal

6. 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%).. 7/7/2019 6 SHAPU in Nepal

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. 7/7/2019 7 SHAPU in Nepal

8. METHODOLOGY 7/7/2019 8 7/7/2019 8 Search engine Google Scholar PubMed 30 Key Word SHAPU in Nepal, Endophthalmitis 3 15 2 10 320 Read article Arrival article Used article

9. 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.. 7/7/2019 9 SHAPU in Nepal

10. 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 7/7/2019 10 SHAPU in Nepal

11. 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) 7/7/2019 11 SHAPU in Nepal

12. A typical case of SHAPU- A child presenting of unilateral nonpainful red eye with white pupil 7/7/2019 12 SHAPU in Nepal

13. SHAPU patients presenting with similar clinical features 7/7/2019 13 SHAPU in Nepal

14. 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. 7/7/2019 14 SHAPU in Nepal

15. 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. 7/7/2019 15 SHAPU in Nepal

16. 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 . 7/7/2019 16 SHAPU in Nepal

17. 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. 7/7/2019 17 SHAPU in Nepal

18. 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. 7/7/2019 18 SHAPU in Nepal

19. 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. 7/7/2019 19 SHAPU in Nepal

20. Among the 10 recent cases, two children have low vision even after operation, while others have their vision intact. 7/7/2019 20 SHAPU in Nepal

21. 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. 7/7/2019 21 SHAPU in Nepal

22. 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. 7/7/2019 22 SHAPU in Nepal

23. 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. 7/7/2019 23 SHAPU in Nepal

24. 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):198-198 7/7/2019 24 SHAPU in Nepal

25. Any question?? 7/7/2019 25 SHAPU in Nepal