Surgical cotton production has drastically been increased in the past few years due to excessive use by medical health professionals especially in countries like India, which is among the top three exporters of cotton worldwide. The effluent generated from surgical cotton industries differ from textile effluents by the conspicuous absence of dyeing chemicals. This wastewater has a high concentration of suspended particles, COD, dissolved ions, organic carbon, and alkaline pH. Several studies have been published on the treatment of textile effluents and the degradation of dyeing chemicals, while the treatment studies on surgical cotton wastewater have been rarely reported in spite of their potential to cause pollution in receiving land/water bodies. Activated sludge microbes have been extensively studied and well documented in the treatment of several industrial effluent but does not match to the production of valuable biomass from algae. The global energy demand has prompted the scientific community to investigate and explore the possibility of using algae for energy production with simultaneous wastewater treatment. To the best of the authors' knowledge, no research articles have been published which compare the effectiveness of activated sludge microorganisms, microalgae, and macroalgae in removing contaminants from real wastewater. To date, there is a knowledge gap in understanding and selecting the right choice of biological system for effective and economical effluent treatment. In an attempt to minimize this gap, carbon removal by microalgae, macroalgae, and activated sludge microbes were investigated on real effluent from surgical cotton industries. It was observed that the strain of Chlorella vulgaris could dissipate 83% of COD from real wastewater, while consortia of macroalgae (consisting predominantly of Ulvaceae and Chaetomorpha) and activated sludge microbes could remove 81% and 69% of the carbon, respectively. The microalgal growth (in terms of wet weight) increased from 0.15 to 0.3g, whereas the macroalgal wet weight increased from 1.5 to 3g in over 7days of batch experiments conducted in triplicates. This indicated the superlative performance of microalgae over activated sludge microbes in carbon dissipation.
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