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Aeromonas spp., opportunistic pathogens, are listed as a microbiological contaminant on the Environmental Protection Agency's (EPA) Drinking Water Contaminant Candidate List. Culture-based methods for identification and quantification of Aeromonas in drinking water are time-consuming and often fail to differentiate pathogenic species from nonpathogenic ones. This study reports successful development and applications of two real-time PCR assays, based on 16S rRNA gene sequences and a virulence gene (aerolysin gene), for rapid and effective quantification of total and aerolysin gene-containing Aeromonas spp. The assays successfully quantified total and aerolysin gene-containing Aeromonas in source, intermediate, and finished water samples collected from seven water works and one pilot plant. The effectiveness of Aeromonas removal by different drinking water treatment processes was examined by comparing the results obtained from the EPA culture-based method and developed real-time PCR assays. Regardless of the methods, our results indicated that conventional water treatment combination (prechlorination/ coagulation/sedimentation/rapid sand filtration) and membrane filtration alone could effectively remove Aeromonas. Slow sand filtration alone might not be effective. The removal efficiencies by different disinfection treatments were not determined, due to the lack of detectable Aeromonas. No Aeromonas was detected in samples with turbidity below 0.06 NTU.

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Rounds Clinical HistoryA 54-year-old male presented with a several-week history of an enlarging, painless, right submandibular mass. He described recent weight loss of 40 pounds (which he attributed to vigorous dieting) and night sweats, sometimes profuse. Physical exam revealed bulky, matted lymphadenopathy involving the right submandibular area and a large, firm, right testicular mass. Initial PET/CT scanning showed diffuse lymphadenopathy, including submandibular, mediastinal, retroperitoneal, and inguinal. Initial image-directed fine-needle aspiration of the submandibular mass was consistent with B-cell lymphoma. Bilateral bone marrow evaluation was negative for involvement by lymphoma. Right submandibular lymph node and right orchiectomy tissue samples were submitted for histology, flow cytometry, and ancillary studies. Pathologic Findings MorphologyThe supraclavicular lymph node was effaced by intermediate size lymphoid cells with a high mitotic rate and a "starry-sky" appearance (Image 1, A1, A2). The testicle was involved by a large cell process with neoplastic cells approximately 1.5× to 2× the size of the supraclavicular lymph node neoplastic cells and abundant mitoses (Image 1, B1, B2). Flow CytometryFlow cytometry of the supraclavicular lymph node sample revealed a CD5+ population characterized as CD45+, CD19+, CD20+, CD5+, CD10-, CD23-, FMC7-, CD38+, and sIg kappa+ ( Figure 1A). Flow cytometry of the testicle sample revealed a CD10+ population characterized as CD45+, CD19+, CD20+, CD5-, CD10+, CD23-, FMC7+, CD38+, and sIg kappa+ ( Figure 1B). AbstractThe occurrence of B-cell lymphoma with intermediate-to high-grade features and different immunophenotypic profiles involving separate anatomic sites is uncommon. We describe such a case and present results of ancillary studies that characterized this B-cell lymphoma. The patient was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) and intrathecal methotrexate with a good clinical response.