Primary cutaneous nocardiosis can present as an abscess or cellulitis with sporotrichoid morphology. Deep inoculation in the subcutaneous tissue can present as a mycetoma. Mycetoma over the elbow region is rare. We herein describe a case of primary cutaneous nocardiosis presenting as a mycetoma, caused by Nocardia asteroides. The patient had extensive keloidal lesions with few sinuses extruding serous discharge over the right forearm around elbow joint. Initially pus and later, the deep tissue biopsy samples were sent for culture and sensitivity, without suspecting nocardial infection. Gram stain of the pus showed few WBCs and occasional Gram positive branching filaments. Modified Kinyoun stain of the same revealed acid-fast filamentous structures. Culture of the tissue specimen yielded Nocardia asteroides. The patient responded well to a modified Ramam's regime. On follow-up, the patient showed no recurrence at 1 year. Our case demonstrates the need for focused clinical search with a high degree of suspicion, and appropriate laboratory procedures in the diagnosis and management of cutaneous nocardiosis.

Background: Our study aimed to assess the efficacy of 0.1% Octenidine mouthwash as an anti-plaque agent and to assess its effect on gingival inflammation and staining of teeth when compared to 0.2% chlorhexidine gluconate by evaluating the impact on plaque and gingival inflammation as well as on microbial load. Materials and Methods: A three week double blind study was conducted on 69 subjects, aged 20-50 years, with moderate to severe gingivitis. The study population was divided into three groups with 23 subjects in each group: Group A - control subjects received only scaling, Group B received 0.2% chlorhexidine gluconate in addition to scaling and Group C received 0.1% Octenidine mouthwash along with scaling. Clinical and microbiological parameters were recorded at baseline, on 14th day and on 21st day. Subjective and objective criteria were assessed on the 14th day and 21st day. Results: There was a statistically significant reduction in all the tested parameters within all the three groups and between the groups from baseline to 21st day. The highest mean reduction in all the parameters was seen in subjects using 0.1% Octenidine. On comparison with the control group, subjects using the mouthwashes (Group B and Group C) had better improvement in clinical and microbiological parameters from baseline to 21st day. On comparison with chlorhexidine, Octenidine mouthwash significantly reduced plaque (p<0.05) and showed better patient acceptability. However, it was comparable to chlorhexidine in other two tested parameters. Conclusion: Owing to Octenidine’s pronounced and comparable antibacterial properties, it can be a promising candidate for the use in antiseptic mouthwashes.

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