Biomarkers Sequencing and Phenotyping of Seasonal Hyperacute Panuveitis(SHAPU)

In Nepal, there occurs an enigmatic ocular disease called Seasonal Hyperacute Pan uveitis (SHAPU) which presents as a rare endogenous pediatric endophthalmitis but many atypical features like absence of predisposing factors (trauma or surgery), failure to grow organisms from the blood and intra-ocular fluids, seasonal appearance every odd year, unilateral, presenting with a white pupil in red-eye and association with the appearance of moths in the community. The tragedy is excruciating as it affects mostly children, who have long years of life ahead. Though first reported in Nepal in 1975, the etiology remains challenging as to whether it is infective, allergic, immune-mediated, or toxic. Thereby, in absence of definitive aetiology, there are no specific SHAPU treatment guidelines and patients receive a blanket therapy of antimicrobials and steroids with poor visual outcomes. As mentioned before, there are a wide plethora of organisms (of viral or bacterial) origin behind eye infections including SHAPU. And, the studies that were conducted in Nepal, until now, did align on the causative agents of SHAPU. Some studies have reported presence of the bacteria, and some have reported the presence of virus. Therefore, we have proposed the use of metagenomic next-generation sequencing that can identify infection of any origin through the approach of sequencing, including any co-infections

Study Duration: Phase I: 1/11/2020 – 27/05/2021
                              Phase II: 07/2022 – Present
Objectives:
The overall objective is to perform the immunological, molecular, and genomic analysis in the ocular/blood samples of SHAPU cases. This shall be subsequently utilized for SHAPU National Diagnostic protocol & Treatment guidelines formulation.

Outcomes:
In this study, we have identified bacteria responsible for causing SHAPU through mNGS and confirmed them by qPCR using established primer/probes. Additionally, we are planning for prospective sample collection with further investigation of outbreaks in 2023 and 2025.

Team Members:

Principal Investigator(s): Prof. Dr. Rajeev Shrestha

Co-Investigator(s): Nishan Katuwal, Dr. Angira Shrestha, Dr. Ranju Kharel, Dr. Pratap Karki, Dr. Sagun Narayan Joshi, Dr. Ananda Joshi

Project Coordinator/Molecular Biologist: Nishan Katuwal

Research Assistant(s): Sony Shrestha and Sneha Shrestha

Supported by: The Global Ophthalmology Awards Program (GOAP) and University Grant Commission

Collaborating Partners: B.P. Koirala Lion Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Nepal