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New Clinical and Laboratory Findings of SHAPU
Anu Manandhar1, Todd P Margolis, Bhaiya Khanal
1Tilganga Institute of Ophthalmology.
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.
Insights
Seasonal hyperacute panuveitis (SHAPU) is often caused by bacteria, not viruses. Early presentation significantly improves visual outcomes in SHAPU patients, though a link to moths remains unproven.
Area of Science:
- Ophthalmology
- Microbiology
- Infectious Diseases
Background:
- The etiology of Seasonal hyperacute panuveitis (SHAPU), or seasonal endophthalmitis, remains unconfirmed.
- Previous studies have isolated bacteria, VZV, and anellovirus, with a suspected but unproven link to moths.
Purpose of the Study:
- To investigate the clinical and microbiological characteristics of SHAPU.
- To explore potential indirect evidence linking SHAPU to moths.
Main Methods:
- A prospective longitudinal study of SHAPU cases at Tilganga Institute of Ophthalmology in 2009-2010.
- Comprehensive ocular examinations and microbiological analysis of vitreous fluid from affected eyes.
Main Results:
- 66 SHAPU cases, predominantly children, were identified. Bacteria were isolated from 9 cases.
- No evidence of HSV, VZV, or CMV DNA was found via PCR in 48 cases.
- Early presentation (within 7 days) correlated with better final visual acuity (≥6/60) compared to later presentation (p=0.001).
Conclusions:
- Herpes viruses are unlikely causes of SHAPU; bacterial involvement is more frequent.
- Prompt medical attention is crucial for favorable visual prognosis in SHAPU.
- The role of moths in SHAPU pathogenesis requires further investigation.
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