Moth hair in cornea in a case of seasonal hyperacute panuveitis.

Seasonal Hyperacute Panuveitis (SHAPU) is a seasonal and cyclic uveitic disease reported only from Nepal occurring every odd year. Untreated eyes go blind and phthisis within a week. Circumstantial evidence for the role of moths has been reported earlier. Herein for the first time, we describe a SHAPU case in a healthy young Nepalese patient where the exposure to white moth was followed by the development of the uveitis and the moth hair particles was detected in the corneal and presence was confirmed with anterior segment optical coherence topography.

Youngest reported Seasonal Hyperacute Panuveitis case.

PURPOSE: Seasonal Hyperacute Panuveitis (SHAPU) is a mysterious but rapidly devastating intraocular inflammatory disease reported only from Nepal during odd years after monsoon. Though it predominantly affects children, it has been reported between 9 months and 50 years age. But herein, we report a case of SHAPU in a 38-days-baby during 2017 SHAPU outbreak. OBSERVATIONS: Parents of a 38-days-healthy male baby from Pokhara noticed redness in child's right eye since 5 days (October 2017). They noticed the fall of a white moth from the tubelight over the child's face 1-day prior to symptom onset. On examination, both eyes followed and fixated at light. The right eye was congested with dense anterior chamber reaction and white pupillary reflex obscuring the glow of the retina. Ultrasonography showed hyperechoic vitreous shadows with choroidal thickening. Left eye was normal. The child underwent vitreous tap with core vitrectomy + lensectomy with intravitreal antibiotics and steroid ↓GA. The blood investigations were normal and the vitreous sample yielded no organism growth. Viral PCR analysis was negative. The intraocular inflammation decreased and fundal glow was visible. CONCLUSIONS: AND IMPORTANCE: SHAPU can occur in a child as young as 38 days. Link with moth remains the strongest suspect.

SHAPU: Forty years on Mystery Persists.

In 1975, our team encountered several cases of severe inflammatory eye disease presenting as a white pupil in a red eye with rapid loss of vision. The eyes became soft within a few days with shallow anterior chamber which we called "Malignant Hypotension" in view of the latter's sinister significance. Unilaterally, little or no pain, predominantly affecting children and difficulty in dilating the pupil and keeping it dilated were some of the other important features. Posterior segment was not visible due to massive exudation in vitreous. Microbiological investigations of aqueous humor did not retrieve any bacterial or fungal organisms. All eyes became pthisical in few weeks despite treatment with topical and subconjunctival antibiotics and steroids. 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.

[Pathogenesis of infectious conjunctivitis in Nepal].

PURPOSE: We investigated human adenovirus (HAdV) and Chlamydia trachomatis in patients with infectious conjunctivitis in Nepal. METHOD: We obtained swabs from 6 patients with infectious conjunctivitis in a remote area near the Indian border (group A), and from 30 patients at the B. P. Koirala Eye Center of Tribhuvan University Teaching Hospital in Kathmandu (group B). Rapid diagnosis of HAdV was conducted in Nepal, using Capilia adeno eye (Capilia), a rapid adenoviral antigen diagnostic kit using immunochromatography. Residual swabs were brought to Japan and examined for HAdV and Chlamydia trachomatis using polymerase chain reaction (PCR). Etiological analysis of 214 patients with trachoma was also investigated by PCR. RESULTS: Capilia results were negative for the six samples of group A and positive for 13 patients (43%) in group B. PCR showed one (17%) as positive in group A and 30 (100%)in group B. The serotype of all HAdV positive samples was HAdV-8. C serovar of Chlamydia trachomatis was detected in ninety seven cases out of 214 patients with trachoma. CONCLUSION: HAdV-8 and Chlamydia trachomatis serotype C seem to be prevalent in Nepal.