Human Alveolar Echinococcosis, Czech Republic, 2007–2014

liver, lungs, or environment (online Technical Appendix Table 2). CPXV infection may manifest in severe ocular forms along with self-limiting cutaneous pocks (5). Our patient had keratitis with no other identifiable cause but CPXV. Culture and PCR from early conjunctival samples and serology confirmed the etiologic diagnosis. Our case and that of another report (7) highlight the challenges of treating cowpox keratitis. Topical and systemic antiviral drugs and AMT appear ineffective during the acute phase. Corneal melting and scarring continued as long as CPXV was observed and until combined limbal stem cell and AMT treatment had favorable outcomes. Anamnesis of therapy-resistant keratitis should include information on rodent contacts. We dated the infection to mid-August (incubation 7–21 days). Catching OPV-IgG–positive rodents close to the patient’s home 2 months after onset showed that OPVs were circulating in the local rodent population and indicated the putative role of CPXV-infected voles as the source of infection. The latest cowpox outbreak in Central Europe involved several humans and pets (8). This patient was born in 1977, after Finland ceased smallpox vaccinations. Declining cross-reactive smallpox-vaccination immunity enables emergence of unusual cowpox infections in humans (9).