Emergency - Fish Diagnosis Needed!

[MechEng99]

Hi all,

I was given this Watanabe angel by a LFS since she had black turbellarian worms and Amyloodinium. Needless to say, she was near dead when I got her, but she's come around. Now...she has this horrific thing. What is it? I thought it was either Vibriosis or Uronema. More details below.

First night...(Thursday)
- Acclimated
- Freshwater dip w/ methylene blue @ 30 minutes (worms seemed gone)
- Placed into QT w/ formalin
- No appetite
- Gasping at surface...breathing rate around 180 breaths/minute

Second night...(Friday)
- Freshwater dip w/ methylene blue @ 10 minutes (velvet lessened)
- Placed into new QT w/ formalin
- No appetite
- Breathing slowed to ~70 breaths per minute
- Noticed lighter patch on her side
- Very twitchy

Third night...(Saturday)
- Freshwater dip w/ methylene blue @ 10 minutes (skin nearly clear)
- Placed into new QT w/ Furan 2
- No appetite
- Breathing is good
- Patch worsening...grows noticeably larger w/in hours
- Very twitchy

Fourth night...(Sunday)
- Added second dose of Furan 2
- No appetite
- Breathing is good
- Patch is really bad...might've hit the blood stream?
- Noticed second patch starting
- Very twitchy

This is her just yesterday:

So... at first I thought Uronema, but I would've thought the 3 freshwater/methylene blue dips plus the formalin baths would've stopped it. Then I thought vibriosis, but the Furan 2 isn't helping. Did I start the Furan 2 too late? Any other ideas on what it might be?

The scary thing is that I had three anthias in the same quarantine tanks (they were brand new setups at the time.) They all developed the exact same thing and died. I thought they were fighting and that the wounds were inflicted by the others. I tried treating with erythromycin (all I had on hand at the time), but that did nothing. After they died, I bleached all the tanks, dried them, and let them sit for about a month before setting them up for this fish.

What's going on and how do I deal with this??? I'm terrified to get another fish now.

 

[sail33]

If it is vibrosis, you've got a tuff job. I'm sorry, I don't know enough to identify the problem. All I can do for you is provide some links you've probably already seen.

The images I found seem to show uronema as a more red patch. I thought my yellow tang had uronema. I used Special Blend as directed and it cleared up. Plenty of people told me that Special Blend was " snake oil" and worthless. All I can say is that tang is fat and healthy now. I hope this helps..

http://www.helium.com/items/1655919-aquarium-fish-vibriosis-causes-and-treatment

http://www.aquaticcommunity.com/disease/uronemamarinum.php

 

[MechEng99]

Thanks sail33 - it's nice to at least hear from someone! I've been scouring the web looking for anything and everything. I'm trying to find kanamycin since that med can be absorbed through the skin and hopefully treat a more internal infection (if it's gone past the skin.)

I really think it's vibriosis. I just checked on her, and the patches haven't grown since last night. I'm not getting my hopes up...but at least it didn't get worse. The scales have definitely retained fluid (quite puffy and sticking out).

 

[HumbleFish]

Vibriosis is a gram negative bacterial infection, so the nitrofurazone in Furan-2 should treat it. However, sometimes antibiotics can be slow acting and may require several rounds of treatment. The fish may not look like it's getting better, but it is getting better so long as you continue treatment. But I also need to point out that gram negative infections are usually more serious (and have higher mortality rates) than gram positive.

Now, if this is Uronema marinum then it's a whole different ballgame. Your best hope for that IMO would be chloroquine phosphate. But I've also read that nitrofurazone has some "antiparasitic action" and can be used to treat Uronema. F/w dips, hypo, methylene blue, copper, malachite green are other suggested treatments; but I have no idea if any of those actually work. But if I couldn't get my hands on some CP, cupramine combined with nitrofurazone would be my #2.

 

[MarinaP]

There was a similar case at our local club. Fish was taken to the vet and diagnosed with trichodina. Treatment is FW dip and hypo in QT. You might want to start hypo.

We suspected vibrio, but it was ruled out.

 

[MechEng99]

Thanks for the opinions and advice!

I'm really leaning toward vibriosis since the treatments I've used so far (freshwater dips, tank transfers, and formalin baths) would've at least lessened the symptoms if it was caused by Trichodina or Uronema.

The Furan 2 seems to have at least slowed the progression (but it definitely is still getting worse.) I'm not sure how much hope I have...can't find too many cases of fish healing well from vibriosis. I think with as bad as she is right now, I'll just continue the Furan 2 until something happens one way or the other. I don't know that starting a new treatment is wise.

 

[MechEng99]

So, a kind soul sent me a PM asking about the outcome for this fish. Unfortunately, she didn't make it. I contacted Bob Fenner, and his recommendation was out of my skill level. He recommended a “subcutaneous injection (intramuscular) of Furan, Sulfanomides”.

I ordered the Kanamycin which helps with internal infections, but it didn't arrive in time.

If I come across this again, I will immediately start Furan-2 and Kanamycin. In fact, I think I may treat regardless since the progression and prognosis is so severe. I already treat for ich/velvet/brook/parasites, so one more thing shouldn't be a big deal.

Thanks for all the support.

 

[alprazo]

Having had battles with both Vibrio and Uronema - this clearly looks like Uronema to me. I have had some success with chloroquine. The gold standard is formalin. It does work. Unfortunately the parasite does not need a host to live and can sustain itself for years without fish only to return when an immune system drops and the fish is susceptible.

For Vibrio - I have found the best treatment to be a series of injections of intramuscular enrofloxacin.

 

[MechEng99]

Having had battles with both Vibrio and Uronema - this clearly looks like Uronema to me. I have had some success with chloroquine. The gold standard is formalin. It does work. Unfortunately the parasite does not need a host to live and can sustain itself for years without fish only to return when an immune system drops and the fish is susceptible.

Please read my initial post. I initially treated (before symptoms started) with freshwater dips and formalin, which would've treated Uronema. Bob Fenner agreed.

The fish were treated in a QT tank, which was bleached between fish, so your last comment about Uronema is not applicable.

 

[alprazo]

Wow. I have never seen a case of culture positive vibrio in a fish without ulcers or subcutaneous nodules. If the skin ulcerated than I would agree that vibrio is the likely culprit. Unless you tell me otherwise, and for the sake of others on this board having similar blanched shallow erosions in their fish, uronema must be considered.

I have a pathology lab and can often confirm the dx, but your so sure, why bother.

 

[MechEng99]

alprazo - you have no right to be rude to me. You recommended treatments that I completed with no result as mentioned in my original post. This is what she looked like when I decided euthanasia was best:

 

[alprazo]

Now that I see the ulceration, I agree on vibrio.. I have seen culture positive polymicrobial gram positives cause identical signs and symptoms but you go with what is common and vibrio would be the diagnosis in your fish.

In understanding the nature of Uromena, it is more than a skin infection. Formalin will only treat the skin and gills. It will not treat dermal and systemic disease. Therefore it works only in the earliest infections. Also, as you have learned, even the proper treatments do not always work. From your time line it appears your fish was sick from day 1. To assume that 2 treatments of formalin plus hypo without results, and the agreement of Bob Fenner, would completely rule out Uromena is premature. You didn't drop vibrio because the furan wasn't working. To also dismiss the condition because the tank was sterilized does not exclude carriage or infection from your fish prior to treatment and therefore it is relevant, especially for others reading this post and first learning about both uronema and vibriosis. Maybe I misinterpreted the tone of your reply, I apologized for being rude. I applaud you for your attempts to treat this fish, in the end you nailed the diagnosis. As for intramuscular injections, it should not be beyond your ability. Supplies and meds can be obtained from a vet or a vetrinary pharmacy. I can point you in a good direction if you have trouble sourcing what you need.

 

[MechEng99]

alprazo - thanks for the apology. I, in my opinion, did the best with what information and treatments I had available. I searched for hours through Google Scholar trying to find studies on Uronema and Vibrio. The Furan-2 seemed to slow the progression, but the fish didn't make it through the full course of treatment. What is your opinion of kanamycin?

So, what's your quarantine/treatment procedure for fish? This is mine, and I'm always looking to improve it:

Day 1: 5 minute freshwater/methylene blue dip, into QT tank w/ Furan-2 to help prevent infection from any parasites dropping off.

Day 2: Repeat Furan-2 dose

Day 3: 5 minute freshwater/methylene blue dip, into new QT tank w/ Furan-2. Bleach previous tank.

Day 4: Repeat Furan-2 dose

Day 5: Transfer fish into new QT. Bleach old tank. Start PraziPro

Day 6: Continue PraziPro

Day 7: Transfer fish into new QT. Bleach old tank. Continue PraziPro

Day 8: Continue PraziPro

Day 9: Transfer/continue Prazi

Day 10: Continue Prazi

Day 11: Transfer/continue Prazi

Day 12: 25% water change and run carbon

Day 13: Move into display

From my reading, that should treat amyloodinum, cryptocaryon irritans, internal parasites, brookynella, some secondary infections, etc.

These are the meds I have on hand for fish:

Chloroquine diphosphate (haven't tried this yet)
Furan-2
Erythromycin
Kanamycin
PraziPro
Fluke Tabs
Formalin
Methylene Blue

As far as intramuscular injections go, I have no idea how to deal with that. I have a good dog vet, but I have no idea if they treat fish. Do you know of a good tutorial or book on how to give intramuscular injections?

 

[alprazo]

Not much has change from this post. The one thing I didn't include was pure oxygen. It is important to have a bottle on hand with an airstone and DO meter.


http://reefcentral.com/forums/showthread.php?t=2128318&highlight=medicine+cabinet

All of my fish go through prazi and chloroquine at the same time. Recently I have been adding Dimilin for sharks since pods are a common problem.

I do not use prophylaxis antibiotics. Only when I suspect an infection. I try to avoid the azole meds like febendazole, also formalin and Dylox unless it is a last resort. They are just too potentially toxic to use on every fish. I'm not convinced methylene blue helps unless you are having a nitrite problem. A water change and pure oxygen would solve that problem.

BTW, you did a good job diagnosing it. The fish may have been salvageable with IM injections though no one could fault you for putting it down. It was obviously really bad shape with a poor immune system.

 

[MechEng99]

I am not worthy... I haven't seen many well-stocked fish medicine cabinets like yours. Do you have a good resource for me to learn how to do intramuscular injections? I'd like to be prepared in the future.

So you haven't had problems running prazi with chloroquine? I'm going to try the cholorquine for the first time tonight. I also don't use formalin unless it's a last-ditch method.

Thought you'd be interested to see this other one I got...
http://web2.reefcentral.com/forums/showthread.php?t=2028995

 

[Thepopo]

Al is that Chloroquine Phosphate? What do u think of quinine sulfate with prazi? I did hear that the combination of quinine based drugs and prazi lowers the prazi efficiency. What are your dosage levels when used together?