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FAQs on Freshwater Protozoan Parasite Disease Involving Hexamita/Octomita

Related Articles: Freshwater Fish Diseases, Freshwater DiseasesFW Disease Troubleshooting, Ich/White Spot Disease, Choose Your Weapon: Freshwater Fish Disease Treatment Options by Neale Monks, Formalin/Formaldehyde, Malachite Green,

Related FAQs: Freshwater Protozoan Parasite Diseases, Diagnosing/Identifying FW Protozoan Diseases, FW Fish Parasitic Disease 1, & FAQs on: Diagnosis/Identification of Parasites, Internal Parasites, FW Parasite Treatments, Freshwater Protozoan Parasite Diseases, Diagnosing/Identifying FW Protozoan Diseases, ( Ich/White Spot Disease, Freshwater Velvet, Sporozoan Parasites, Whirling Disease, & Cichlid Disease, African Cichlid Disease, Aquarium Maintenance, FW Infectious DiseaseFreshwater MedicationsAfrican Cichlid Disease 1, Cichlid DiseaseBetta Disease 1

Considered by many to some as the/a causative organism for the neuromast destruction called "Head and Lateral Line Disease" in fishes. Often one cause for "stringy white feces"... Most often treated with/through foods laced with protozoacides (e.g. Flagyl/Metronidazole)?

Kribensis and Camallanus   3/21/18
Both of my tanks, a 55 gallon and a 40 gallon are currently being treated for Camallanus with Levamisole after I had a couple of suddenly ill and now dead fish.
<Levamisole is a good choice here: relatively safe, and should not, in itself, cause stress or harm to your fish, assuming it's used as directed.>
I noticed my Kribensis in the 40 with typical red bristle-looking worms protruding from her vent.
<Sounds like Camallanus!>
So far, both tanks are doing fine, but this particular Kribensis has made a 180. She’s social now, eats voraciously and doesn’t hide between the filter and tank anymore.
I thought she was just an antisocial fish. However, without exaggerating, she has had a 2-3 inch, maybe longer, poo coming out of her for the last 4 days.
<Quite normal when de-worming. Sometimes the gut becomes irritated, whether by the worms or the medication, and produces a lot of mucous. Such mucous will form off-white to clear strings that contain little faecal material, hence the lack of colour. If this persists for too long, say a week, you might think about Hexamita infection, which is extremely common in cichlids, and also causes white, stringy faeces (largely for the same reason, irritation of the bowel by the parasites). In this case, Metronidazole is the treatment.>
I have seen nothing that looks like a warm, just regular poo. And it’s not the same poo, but generally, if you look at her, it’s there. Occasionally she darts quickly and it finally breaks free. After treatment, her very pale body developed some color, but apparently any plumpness she had is gone. Is this continuous bowel movement normal after a dosing?
<Can be.>
Was she just severely constipated?
<Could certainly be a factor, yes. If the cichlid is otherwise behaving normally, nice colours, feeding well, socialising, and displaying no unusual sores or pits on the lateral line or head (which often happens with Hexamita infections) then all should be well. Finish the treatment as/when instructed, do a decent water change, 25-50%, and see how things go!>
Thank you for any information!!
<You're welcome. Neale.>
Kribensis and Camallanus   3/21/18

<Oh, and by way of a timely post scriptum, Bob has just published a piece of mine on identifying and treating 'worm' parasites that might well be useful:
Cheers, Neale.>
Re: Kribensis and Camallanus     3/27/18

Hello Crew!
I inquired a few days ago re: Kribensis with Camallanus worms treated with Levamisole. The Krib had done a total about face after dosing, much more energetic, eating voraciously, suddenly social etc.
<Good to hear.>
However, there was the issue of her continuous, long, and ever-present poop. Neale suggested that if this continued for a week, then possibly need to treat for Hexamita.
<Yes; ideally alongside an antibiotic such as Nitrofurazone that offers the best "one-two" punch against a range of common ciliates and bacterial pathogens.>
Well, she's still winning the world record here with the long, seemingly continuous poops. Going on 2 weeks now.
<Do also try Epsom salt (helps with constipation) and high-fibre foods (cooked peas if she'll take them; brine shrimps and daphnia if she won't).
These are both harmless to the healthy fish, so feel free to treat in the tank, alongside the Metronidazole and Nitrofurazone.>
She even fasted as couple of days, and still... So, I plan on finishing the Levamisole treatment this week, and then start with Metroplex and Focus (Flagyl/Metronidazole as medicated food). Does this sound like a plan?
She is still quite pale and skinny, but still behaving much much better than before the treatment for Camallanus.
Thanks for any advice in advance...and your help over the years has been like solid ground for me when things get shaky!
<Glad to help. Cheers, Neale.>

Hexamita  ( hole in the head ). Trtmt. w/ Metronidazole/Flagyl FW      2/6/14
hi, hoping you can help me. I have a 180 Lt tropical tank with a large variety of fish silver sharks, Plecs, bristle nose, elephant nose, ghost knife fish, flying fox’s, angles, and clown loach’s two of my four clown loaches have Hexamita and have gone of eating. I have had a veterinarian give me a scrip of 400 mg Metronidazole to treat Hexamita at a dose rate of 11 tablets day one, day two 50% water change, day three 11 more 400 mg tablets, treatment via water disbursement. After reading your blogs and many others I am now confused as to what dose rate I should use as I feel 22, 400 mg tablets in three days  is going to be a major over dose. Could you please help me with a dose and treatment rate, I have been unable to remove clown loaches to a quarantine tank as it is currently occupied with new stock and do not want to risk putting them at risk,  regards Andy
<In looking up in Noga's 2d edition, I see a similar protocol ascribed to Langdon (1992a): 25 mg/l (95 mg/gallon... every other day for three days... IF you have 180l... this would come out to 4,500 mg... close to 11 pills. Though some other writers (myself included) call for other SOPs (usually 25 mg/gallon...), and advise one treatment orally over long immersion; I don't think you'll overdose these fishes going the suggested route. DO have the change out water on hand just in case. Bob Fenner>

Bonsai FH recovering from Hexamita (?) – 07/27/12
Dear Lifesavers at WWM,
I have a Bonsai red flame Flowerhorn (?) (exactly like http://www.monsterfishkeepers.com/forums/showthread.php?328310-Bonsai-Red-Flame-Flowerhorn-Female-TX-Shipping-or-PU),
who is trying to recover from a severe case of Hexamita or perhaps a Swimbladder disorder or bloat (I am not sure).
My problem is a little involving, and you may think it is useless to do anything at this point, but I request you to please bear with me. I have few specific questions in the end.
Though my Flowerhorn (FH) went through very rough times in the last 6-8 months, I am mentioning the events only in the last couple of months. She started to develop a grotesque bloat and went upside down floating at the top of the tank, and a significant part of her belly was outside the water.
She also had something coming out of the anus (the prolapsed colon, or perhaps the swimbladder).
Initially, I tried feeding her with Metronidazole soaked blanched peas, and Epsom salt in the water (20g/20G), but that was not enough. So, after a couple of weeks, I removed the carbon from both the filters and started dosing the tank water with 500mL Metronidazole (ivy) solution in 20G water.
<Into the water? Of very little use>
I absolutely had no hope for her, and everywhere I asked for opinion/help, I was asked to euthanize her. I just could not do so, because every single time I looked at her, she tried to swim and come down in the water and showed immense energy. So I decided to continue with the medications and see what happens. I am only hoping that I am not torturing her with the medications.
With this regime, her bloating subsided and she came under the water (still in upside position and with prolapsed colon). In hope of further improving her condition, I added Nitrofurantoin (150mg/20G) last week. Her prolapsed colon (or perhaps swimbladder) disappeared within a single day, but there was still a little bit of swelling just near the anus. Also, she turned sideways from upside down. I was unsure of the reason for turning sideways, so I removed all the Nitrofurantoin from the tank (cleaned the canister filter, did 50% water changes 4-5 times). I did not have much hope for her *till today when I saw her trying extremely hard to swim straight and she could manage to do that for a very short time*. I saw her straight (glimpse of) after many months! Thank god!
She mostly sits sideways in one corner trying to rest on the filter inlet pipe, and occasionally swims in the horizontal (disc like) position.
I still don't know what is going to happen, but I think she has better chances if I can find answers to the following questions. I will really appreciate if you can help me here -
1. Diet: What should I feed her? She has been literally on blanched peas for the last 2-3 months.
<A high quality pelleted food: Spectrum or Hikari>
I used to feed her Hikari Cichlid Excel, but in recent past she turned upside down whenever she ate that. I gave her few pieces of garlic soaked blanched prawn a few days ago, which she liked. Can I continue this?
<Not indefinitely, no. See WWM re Thiaminase>
On your website, I read that Vitamin C is good for Cichlids recovering from diseases. Should I buy some Vitamin C capsules and put in the water? How much?
<Best to buy a prep. made for ornamental aquatics, e.g. Selcon...>
I tried feeding Oranges (blanched), but she just does not want to touch them. Any other source of Vitamin C for fish? Few months ago, I tried adding Vitamin B-Complex capsule, and she developed a bloat.
2. Should I add Metronidazole in the food again?
<I would not, no. Trouble to expose fishes more than once>
3 I have reduced the Metronidazole concentration to 200mL in 20G with about 5-10gms Epsom salt. I plan to slowly withdraw the addition of Metronidazole over the next week. Given that she is getting better, should I still try to add Nitrofurantoin again? How about Epsom salt?
<... w/o knowing what the actual cause of troubles are, ameliorative remedies are hard to recommend. I wouldn't be adding anything>
4. What is the right pH for this species (
<Not a species; but a hybrid, cross. Low to mid 7s... same as hardness, alkalinity (GH, KH)>
I saw an extensive article on your site to maintain pH, which I am going to follow. What exactly is the name of this species? I see names like short body/albino/bonsai FH. Out of curiosity, is this really a FH or a parrot Cichlid?
<The former>
5. Few days ago, when she tried swimming she went in circles. I checked online, and I don't think it is whirling disease (her colors are intact, and she is at least 1.5+ years old). Are there any other symptoms for this disease that I can check for?
<... see WWM w/ the name>
6. Sometimes, I see her curved on one side. I am pretty sure it is not TB, or broken spine. I believe that it is due to the swelling on one side that she goes bent towards the other side. Are there any specific reasons for this?
<Can be or not>
Here are some of the details about my setup:
Tank size: 45G (is filled only half to 20G, because she is upside down)
Filter: 1300LPH external canister filter, and an internal 1000LPH (I keep the internal filter off most of the time, because it creates a heavy current that my fish does not like).
Temperature: 29 degrees Celsius with lots of aeration.
I am changing 30-40% water every alternate day for the last 3 months, so I am hoping the water parameters (except pH) are good and thus not mentioning here. She is the only fish in the aquarium, and is about 4 inches in diameter.
Thank you for your time and patience.
God bless you!
<Please (re) read all that is archived on WWM re Flowerhorns:
and the linked files above. Bob Fenner> 
Re: Bonsai FH recovering from Hexamita (?)    7/27/12

Hello Bob,
Thanks a bunch for dealing with my rather vague questions. I am not sure what she is suffering from, and I don't have a vet around, so there is no way to figure it out.
<Mmm, yes there is... sampling, microscopic examination, reference books>
But from my limited understanding through online research, I feel it is Hexamita. Although, I am not sure if it causes the fish to go upside down and then sideways.
Yes, I've read most of the articles on Flowerhorn on WWM. I searched "Flowerhorn" on WWM, and read all the articles on the first two pages of the results. And from Neale's article, I realized that it is best to used Metronidazole + Nitrofuran for a cichlid when you are unsure of the problem. And which is why I asked you if it is okay to add Nitrofurantoin in the water.
<... is likely not to be of any positive use here>
Anyway, I will continue with Metronidazole (ivy) in water for another week, because that is how she has improved. I will start on Hikari pellet food (Hikari Cichlid excel or gold) again and hope for the best. I don't get Spectrum in my country, but I will try to see if some shop stocks it.
I will also start working on maintaining the pH (that is one thing I am not doing currently).
Thank you again.
<Welcome. BobF>
Re: Bonsai FH recovering from Hexamita (?)    7/27/12

Hey Bob,
So you mean I can take the water and/or stool samples to a diagnostic center (for humans) and get it tested for fish bacteria? Can you please tell me the tests (or point me to a location that lists some tests) that I should get done? Usually, when I get my blood tests done, the doctor specifically writes what to check for. E.g. sugar level or something like that.
<No; I would not do this. Not likely to provide you w/ useful information>
Thanks for the great suggestion. I don't know why it never occurred to me!?|
<There are a few stock reference works on fish disease. Can you borrow a copy (first or second ed.) of Ed Noga "Fish Disease, Diagnosis & Treatment" possibly? Bob Fenner>
Re: Bonsai FH recovering from Hexamita (?)    7/27/12

Hey Bob,
Thanks! This is what I needed. Just purchased the online version of the book.
<Didn't know this was possible. I hope it was much cheaper. Thank you for this info. >
Although, I am not sure if I will be able to make any head or tails out of it (never studied biology after class X). If I am stuck at something, I may bother you again.
Thank you,
<Never a bother. BobF>

Metronidazole, dosing, Hexamita/Octomita/Dempseys   -- 08/25/10
Hi Bob,
<Vu Ma>
First, I wanted to say what a great and educational website you guys have. I tried to read all I could about Metronidazole and Hexamita on your website because I did not want to repost any old threads. So if this is a repost then I want to apologize ahead of time. I recently bought some fish online and it was shipped to me. They all seem strong when they
got in but I think they brought some parasites with them. My 125 gallon tank have been up and running for about 6 months. Water parameters are: pH: 7.8, Ammonia: 0, Nitrite: 0. The aquarium is heavily planted, but my fish is more important than the plants. I am religious about doing weekly water change. I overkill on filtration. I have a Fluval FX5, Fluval 305, and a Aquaclear 110 for this aquarium. I recently noticed that my fish were scratching so I just put some salt in the tank as a precautionary measure.
Well, today I notice 2 of my EBJD <electric blue Jack Dempsey...> are not eating and one has a gray spot on his head. They are both pooping out stringy poop. So I did some research and expect they have Hexamita.
I have bought some Metronidazole to treat the fish but I have some questions about the dosage and usage. First, should I remove all the salt and wait a week so I can give the fish time to recuperate from the salt solution?
<Not necessary>
Is Metronidazole safe with salt?
I am afraid that if I wait a week that the fish would be to far gone to be rescue. I am going to treat the whole aquarium since Hexamita is so contagious and plus my 2 EBJD aren't eating. How long should I use Metronidazole in the aquarium water?
<One dose... with good percentage water changing a week later>
I mean until the symptoms are gone or for a certain amount of days. Is the treatment every other day or everyday and is it
with a 25% water change or is it with a 50% water change?
<One treatment should do it>
If and when my 2 EBJD start eating again should I try to add Metronidazole to their food or will that be too much since it is in their water already?
<I might add it, but just once>
I definitely do not want to overdose my fish but I really want to eradicate this parasite.
Thanks in advance and have a wonderful day.
<Welcome and you as well! Bob Fenner> 
Re: Metronidazole -- 08/26/10
Hi Bob,
<Big V>
- I just wanted to say thank you for getting back to me so fast. I just have two more quick question. I am using the Seachem brand.
According to them I should use 125mg for every 10 gallons. Do you think that is a good dosage or should I go stronger? I have read that I should do 250mg per 10 gallons.
<Can... Blasiola and Gratzek, 1992, suggest doing this daily for three times... Langdon (1992a) suggests even more (95 mg/gal.) added every other day for three treatments>
I also heard that Metronidazole is not very water soluble. What is the best way to mix it into water?
<Whip it into an aliquot; add this>
Should I heat the water up and mix the medicine, than let it cool and put it in the aquarium?
<No need to heat>
Again, thanks so much for sharing your knowledge and have a wonderful day.
<Welcome. BobF>

sick discus, help !!!!!!!!
Sick Discus  3/8/10

I have a sick discus and I'm pretty sure he has Hexamita he has white stringy feces and is not eating one fish make that two fish have already died the pet store gave me some Metro. But I'm not sure how to properly administer this ??? the website where I found you says soak food in 1 percent metro 1 percent of what ??? how much metro is that ??? a teaspoon tablespoon in terms of quantity I don't know ???? and what do I put some Metro in a cup and throw fish cube in it and just let it soak in the fridge??? I also read 250mg of Metro directly into the water per every 10 to 20 gallons ???? I'm greatly confused I don't anymore fish to die please help !!!!!! Thanks, Freddie Baigen
< If your discus is eating , then getting the medication into the food is the best treatment. Check the ingredients for the medicated foods at the fish store. If they don't have it then you can buy it online at Drsfostersmith.com. You can also buy the medication to add to the water directly. In the meantime I would recommend a 50% water change, clean the filters and vacuum the gravel. Organic matter seams to interfere with medications.-Chuck>

Golden Severum with red stripe and streaking  4/28/09
Hi and thank you;
I wrote in about 3 weeks ago. I have a 7 inch Golden Severum and he is the only fish in the tank. He started out with a round bump/lesion in his head about a month ago, vertical swimming, some stringy poop and he stopped eating.
<Sounds like an Hexamita infection; usually related to water quality, especially nitrate, but may also be triggered by inappropriate diet and possibly other factors like insufficient oxygen concentration. Since
Severums are herbivores, they're probably pretty sensitive to the wrong diet, i.e., vitamin deficiency. This seems to be the case with marine herbivores like Tangs and Angels, at least.>
Since then I have been doing consistent water changes and gave him 2 Ampicillin treatments 3 weeks ago for the open sore. This sore healed completely and there are no others. I felt like he might of run hard into a
rock when startled. I did a parasite clear treatment for the stringy poop and because he was startled.
<Generic parasite treatments generally have little/no impact on the mucous-rich faeces. Hexamita infections are complex; the parasites in the gut irritate the lining of the gut, resulting in lots of mucous, and that's
where you get the stringy faeces. When the parasites migrate around the body, they can infect the lateral line pores on the head, and this is where the hole-in-the-head starts. A part of this problem is that the parasites
allow bacteria to infect the pores, so much of what you see as the "holes" is more bacterial than the Hexamita directly, hence antibiotics may reduce the symptoms. But if the Hexamita infection isn't also dealt with, there's nothing to stop a reoccurrence of the symptoms later on.>
I have been feeding him a variety of foods; mostly mysis shrimp with peas, spinach. For a week I included Metronidazole and used a turkey baster to get this to his mouth. I also treated the tank with Metronidazole 3 times, with 1 day in between, with some water changes. He still has a red stripe from his tail down part of his spine and a small area under his tail, some red streaking in his tail, he hides in a corner for a lot of the day with his head hanging down, but does swim back and forth gently at times.
<The red streaking is likely another secondary bacterial infection.>
At night I have seen him vertical. About 3 days ago I started treating with Kanaplex from Sea Chem and stopped the Metronidazole. His swimming is definitely improved and he resists the food with medication, but always eats some. I have also had the carbon filters out most of this time. There is definitely still something persisting. I thought about combining the two medications. Someone told me he might have developed an intolerance to the Metronidazole and to use something like ParaGuard from Sea Chem in place.
<Hmm... no... Metronidazole is really the only thing that kills Hexamita.>
Do you know what the read stripe and red streak indicate?
<See above.>
What do you feel would be the best treatment?
<Would use both Metronidazole and a suitable anti-Finrot medication, ideally an antibiotic.>
How long should I keep the carbon filters out?
<For as long as you're medicating.>
Is there any better foods to ad? Your help is very appreciated; Andrea
<Cheers, Neale.>

Sick Uaru (Hexamita, diet, environment)  3/1/09  I have been keeping fish for a few years and have a Uaru in a 80 gallon tank. He developed what i believed to be fin rot about 2 months ago which i treated and he healed. He then developed holes in his head with mucus coming out i had seen hole in the head before and his faeces was not white and stringy he only had at first one small one. he had no appetite loss or did he isolate himself. I spoke to a trusted fish shop person who recommended Pimafix, and to keep an eye on it in case he got worse. well the next day he had puss filled holes on his head around his eyes and also on the line down his body that looks like a sewed line (sorry cant think of another way to describe it). In this case i decide to treat him with esHa Hexamita. i have now been treating him as per the instructions for at least a month and he has seemed to improve then as soon as i gave the tank a rest after the three days he acquired more holes. He can be very awkward with the Sailfin Plec that i have and when i first had him he got injured by being spiked which caused a swelling and loss of half of his top lip which would ooze white stuff. two day ago he had a swollen cheek and now he has 4-5 holes down the side of this cheek where i am not sure if the cheek is oozing or it is still as a result of the hole in the head he has one hole on his nose on one side all holes have gone on the side with the swollen cheek he has one that is an original hole and a linear ooze on the line on his side as i described before. he has had 5 treatments with breaks and water changes he is eating some days he isolates in his house other days he is fine. I have put some aquarium salts in and now as there seemed to be and improvement but the holes are back. I have heard now that i cant retreat with the Hexamita as it cant mix with the salt Is this true? and i am so upset that i may lose him if i water change can i treat him and can i put more in than it says or put treatment in until it goes, or for four or five days. I need HELP!! Please? Water quality has been tested There are two gold Severums 2 alliminium catfish and a Firemouth in the same tank MonicaMonica <Hello Monica. Before anything else, my gut feeling here is we're looking at chronic water quality problems. Let me explain. While 80 gallons sounds a lot on paper, the fish you have are both big (the Aluminium Catfish, Chrysichthys longipinnis) and super-sensitive to water quality, including nitrates (the cichlids, particularly the Uaru). I'm also concerned that you're not tackling the problem head-on. There's no need to use "aquarium salt" in a freshwater tank, and any retailer that recommends either salt or Pimafix as the solutions to your problems isn't doing you a good service. The problem is almost certainly lack of space, lack of water changes, and/or lack of filtration. So let's review. Aluminium Catfish can get to 70 cm (over 25 inches) in the wild. Two of them by themselves would need a much bigger tank than you have, something upwards of 800 litres (175 Imp. gallons). On top of that, you'd need a colossal amount of filtration, not less than 6-8 times the volume of the tank in turnover per hour. On the flip side, Uaru amphiacanthoides is a cichlid species at least as sensitive to water quality as Discus, so keeping such a fish in a cramped tank with poor water quality is going to make its life difficult. Putting aside water chemistry issues for the moment, in terms of water quality you need zero ammonia, zero nitrite, and a nitrate level of less than 20 mg/l. It's also a partially herbivorous cichlid, and unless it's diet is rich in green foods, it suffers from vitamin deficiencies rather easily, and these make fish more vulnerable to Hexamita. And I'm sure you're dealing with some type of Hexamita infection here. The reliable cure for this is Metronidazole 250 mg per 38 litres (8 Imp. gallons/10 US gallons). In the UK, you can get this only from a vet. Whilst I'm aware of the eSHa alternative, I've not used it, so can't comment on its efficacy. I'll also make the point that unless you fix the environment and diet, all the treatment in the world won't help. Cheers, Neale.>

Hexamita, help!-- 10/5/08
i have a 100 gallon (US) tank with 4 juvenile jewel cichlids, 4 juvenile tiger Oscars and 2 Plecos. i have two internal power filters, filtering approximately 500 gallons an hour, as well as a thermostat heating system maintaining temperature at a constant 25 Celsius. I
noticed a pair of my Oscars getting lazy and just kind of leaning by themselves up against the corner of the tank. I noticed their poop had turned a greyish white and researched that a primary cause of that would be internal parasites.
<Can be; does rather vary with the parasite!>
Unfortunately in India, where i reside, we don't have the full barrage of fish medication available so i took a metronidazole tablet meant to be taken thrice a day by a human adult powdered it and let it loose in the tank in the hope it would treat the fish. Any suggestions or Advice?
<Should work, assuming the concentration is appropriate (7 mg/l according to Andrews, Exell and Carrington (1988), potentially several times, repeating every other day, with a 25% water change in between). Do also see here:
thank you,
<Cheers, Neale.>

Ulcers on angelfish, FW    8/12/08 The issue in question is currently isolated to my 29 gallon tank. The tank is about 19 months old and decorated with driftwood and a few live plants including Corkscrew Val's, Ludwigia, Anubias, and Amazon Swords. Despite the presence of plants it is by no means a "planted" tank. The lights are controlled by a digital timer. Filtration is provided by an Eheim Ecco 2232 loaded with coarse and fine filter pads as well as Substrat Pro Bio Media. The water is also passed through Current's 8 watt Gamma UV filter fitted with a Mini Jet 606 pump. The water parameters are consistently 0, 0, and 20 ppm for ammonia, nitrite, and nitrate respectively. Inhabitants include 3 angelfish (Pterophyllum scalare) and two Keyhole cichlids. They are feed a variety of quality foods including flake, pellet, and freeze dried worms. <All sounds dandy.> The infected fish is the most recent addition, the third angelfish. This fish was first quarantined for two weeks with no signs of disease. It had been in the 29 gallon tank for about four weeks before the symptoms were first observed. It may be important to point out that this fish is not being bullied, and has always been able to eat it fair share. All other fish have not thus far and have never displayed any symptoms of disease. As far as I'm concerned they have always been in excellent health. <OK.> The first observations of symptoms on this fish were white patches randomly covering the body. These observations were made after a two night vacation. Some were on the right caudal peduncle, one at the base of the caudal fin, another at the tip of an anal fin spine, one spot on the each side's gill cover, and the last just above his mouth. I immediately treated with API Fungus Cure. At the end of the recommended treatment period most white patches were clearing so I continued treatment with Pimafix. At this point I noticed that the white patches left holes or ulcers on each gill cover and the spot just above the mouth. These ulcers are not bleeding or leaking anything, and are not remarkable other than just being present. After this I also added Melafix to prevent possible secondary infection, and to utilize any healing effects that the added Aloe may provide. I also started feeding the only medicated food I had which contains sodium sulfathiazole and Nitrofurazone. <There's really two things that spring to mind: Finrot (or something similar) or Hexamita. Now, Finrot is almost always associated with water quality, but in this instance that doesn't seem likely. Your tank sounds well maintained, though I'd argue a trifle overstocked for five cichlids of moderate size. But your nitrate level is low and the ammonia/nitrite levels are zero, so that's probably not an issue. Physical damage is the other common cause of Finrot, whether through transportation (careless netting especially) or fighting. Angelfish *are* territorial, and I've not seen many trios work in small tanks. On the whole Angelfish work either as singletons, mated pairs, or groups of 6+. Three specimens is a funny number, because you could easily have a pair who resent the newcomer. Angelfish are impossible to sex outside of spawning (and even then they make mistakes themselves!) so this one is difficult to confirm either way. But I would definitely observe their social behaviour. Things like fin flicking and chasing are typical signs of aggression. Angelfish sometimes even make audible croaks when they're being threatening. Next up, Hexamita, a protozoan probably latent in many cichlids but only problematic if conditions deteriorate in some way. Because this is a slow-acting disease, the fish could have developed sickness at the retailer, and only now are the problems manifesting themselves regardless of how well you're caring for them. Hexamita does at least two different things. Firstly it messes up the digestive tract, leading to the classic white stringy faeces, or it causes pits to appear on the face and body (the symptoms known as "Hole in the Head"). Treatment of Hexamita is difficult, but Metronidazole added daily at 250 mg per 10 US gallons for at least 3 days is the standard therapy. Medicated foods work even better if the fish is eating. Now, I have to admit neither Finrot nor Hexamita seems to fit 100% the symptoms you describe; photos would help.> Does it seem like I really have this under control? <Difficult without confirmation of the sickness.> Can I do anything further to heal these open ulcers and how long can I expect this to heal? <You should certainly be treating for Finrot/Fungus if only to prevent secondary infections. In the US Maracyn seems to be the drug of choice for this; in Europe I recommend eSHa 2000. Pimafix/Melafix are largely useless and at best unreliable.> Lastly, what am I dealing with here? <Not sure.> I feel Hole in the Head disease just doesn't seem to fit here. <Agreed, but certainly worth considering.> Certainly pictures I've seen don't seem to match, whereas HITH seems to form pits these are open wounds or ulcers. <One possible alternative is "Discus Plague", a nebulous collection of symptoms with no obvious cause and no agreed treatment. It sometimes affects Angels, particularly commercially bred ones rather than wild-caught ones. I don't think is is likely, but I'm putting it out there for your consideration and research.> Thank you for your time. <Cheers, Neale.>

High Mortality Rate, FW, poss. Hexamita/Octomita    7/1/06 My daughter has had her Eclipse 12 aquarium for a little over a year. We have a high death rate. <Not good> In 13 months we have had about 18 out of 25 fish die.  We test our water regularly at the local fish store and it always test at normal levels. <Mmm, you might want to invest in some simple test gear for your own, at-home use. Many important parameters can/do change in just the short trip to the store... And these tests, testing can be a useful element of education, sharing as well> Deaths include about 6-9 platies, 3 dwarf gouramis, 2 albino catfish, 1 skirt tetra and 2 rasboras. <A broad mix of tolerant species...>   Our original skirt tetra is alive after 1 year and 3 of the 5 rasboras we bought are still alive after 6 months.  Many of the fish wasted away. Also some mainly the gouramis had a hair-like excrement. <... trouble. This could well be indicative of a persistent protozoan parasite (Octomita/Hexamita...)> We finally treated for internal parasites.  We bought our first 2 fish from one of those large chains and believe it might have brought a parasite with it. <Given what you present here, I concur> We did two treatments ( 2 doses each I think) a week or two apart.   <With what medication?> Two fish died after that.  We did not add any fish for at least 2 month after that.  When we did add 3 guppies and 1 dwarf Gourami, the male guppy died after 2 days.  The Gourami died after we added 3 more guppies 2 days later.  I realize we added fish to quickly, but we were given the second batch.  I am wondering if these last two deaths are likely due to stress or are there other things we should try. <Possibly>   The male bloated before dying, the Gourami just died.  I am getting really frustrated and my daughter is getting very discouraged.  Can you give me some suggestions on how to reduce the death rate.   <A few things, yes. For one, if this problem is Hexamitiasis and unless it was eradicated through treatment... it's still there (a very common cause of continuing high losses from and through fish stores). I would treat your system with Metronidazole/Flagyl to be sure. Please see WWM re this anti-protozoal, its careful use, and Hexamita... and particularly here re Gouramis: http://www.wetwebmedia.com/FWSubWebIndex/GouramiDisFAQs.htm and the next FAQ file linked above. Bob Fenner>

Discus with Hexamita? - 02/02/2004 Please help...I don't want to lose me discus fish. I have been treating with rid-ich for 5 days now. The ich is almost gone, but the fish have developed cloudy eyes, a whitish clear coating on their bodies and ragged fins.  <This sounds perhaps like "skin slime disease" - caused by protozoan parasites, likely Hexamita, or possibly Ichthyobodo (Costia), Childonella, Trichodina.... All should respond favorably to Metronidazole administered in food. Metronidazole can be found made by Aquatronics (Hex-a-Mit, green or blue box) and by Seachem (simply Metronidazole).> I have a 55 gallon aquarium. Temp is at 86 degrees. Nitrates, nitrites and ammonia are ok. Ph is at 7. I've been doing a 20 - 25% water change daily, and I added 8 tablespoons of aquarium salt to the water. Please let me know what else I should do.... <A good start - and may in and of itself effect improvement or cure. I would still treat with Metronidazole in food.> Thank you sooooo much, Anna <Wishing you well, -Sabrina> 

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