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Research Letter |

Clinicopathological Findings in Persistent Corneal Cowpox Infection

Sybille Graef, MD1; Andreas Kurth, PhD2; Claudia Auw-Haedrich, MD3; Niklas Plange, MD5; Winfried V. Kern, MD4; Andreas Nitsche, PhD2; Thomas Reinhard, MD3
[+] Author Affiliations
1University Eye Hospital Tuebingen, Tuebingen, Germany
2German Consultant Laboratory for Poxviruses, Centre for Biological Security, Robert Koch Institute, Berlin, Germany
3University Eye Hospital Freiburg, Freiburg im Breisgau, Germany
4Centre for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
5Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
JAMA Ophthalmol. 2013;131(8):1089-1091. doi:10.1001/jamaophthalmol.2013.264.
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Cowpox viruses (CPXVs) belong to the genus Orthopoxvirus.1 Increasingly, CPXV infections have been reported in domestic cats, rats, and exotic zoo animals, with humans potentially being infected through direct contact with these animals.1 Typically, a CPXV infection becomes apparent through the development of small skin lesions. Healing comes with scar formation and can take several weeks. Complications and severe courses have been reported in immunocompromised individuals.2

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Figure 1.
Preoperative and Postoperative Findings

A, Preoperative status of the right eye 18 months after primary infection with cowpox virus. B, Fluorescein staining shows widespread corneal erosion and step formation at the corneal margin (arrow). C, Postoperative finding 1 day after limbokeratoplasty. Arrows indicate the limbal part.

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Figure 2.
Histological Analysis

A, Histological overview showing local bacterial infiltrations (arrow) (hematoxylin-eosin, original magnification ×100). B, The keratocytes seem to be swollen with granular cytoplasmic material (arrow) (hematoxylin-eosin, original magnification ×400). C, Immature virions (arrows) are located in the cytoplasm of keratocytes. Co indicates collagen fibers (scale bar = 500 nm). D, Mature virions (arrows) are enclosed by collagen fibers (Co) (scale bar = 500 nm).

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