Is he doomed?! :(

[Coryloach]

I know we are using the terms hexamita, spironucleus, HITH, etc..interchangeably, but there could be a difference in the type of infestation, particular parasite at play. I know a lot of studies are on spironucleus vortens but the case is not always the same.

Members of the genus Spironucleus are flagellated anaerobic protozoa that parasitize marine and fresh water fish as well as terrestrial vertebrates including mice and turkeys.9,19,25,26,31 Together with other flagellates including Giardia, Hexamita, Enteromonas, and Trichomonas, they comprise a clade known as Fornicata. These organisms are classified as either enteromonads, containing one karyomastigont (nucleus and cytopharynx), or diplomonads with two karyomastigonts. Fornicata are unusual among eukaryotes in that they lack mitochondria, a Golgi apparatus, and cytochromes. Interestingly, some genera are capable of amino acid fermentation for energy production, a trait more commonly found in bacteria than in protozoa.1,2 These characteristics suggest that Fornicata are amongst the earliest and most primitive offshoots in the eukaryotic tree.10

Spironucleus spp. are diplomonads but recently developed molecular phylogenies reveal that reduplication of the karyomastigont has occurred multiple times throughout evolutionary history and that the genus Spironucleus is actually a paraphyletic clade.15 Based on small subunit ribosomal DNA (SSU rDNA) sequencing, Spironucleus species cluster into three separate groups, the first containing parasites of saltwater fish, the second, parasites of freshwater fish, and the third, parasites of terrestrial animals.15

Spironucleus and closely related Hexamita spp., infect a variety of vertebrate hosts, including birds, fishes, mice, and nonhuman primates.

 

[Coryloach]

For example, the below is not a scientific article but has quite good info:

It is also not about spironucleus vortens but about H. salmonis , H. truttae and H. intestinalis

Mode of transmission:

1. Hexamitiosis was transmitted by oral route.

2. The parasites may be transmitted by water to healthy farm.

3. Anal route plays role in transmission of the disease in the case of free-swimming flagellated forms of the parasites.

4. Parasites found in the intestinal tract & under stress, the reproduction of parasites increase and lead to disease.

5. Lesions on skin (especially the head), or at the base of the fins and near the lateral line act as route of infection especially in tropical aquarium fishes.


Clinical signs:

Anorexia, weakness & emaciation are showed on fish infested with hexamitid. The fish become slender. Abdomen is sunken and head is enlarged.

2. Dark coloration of the skin.

3. Pale coloration of the gills with hyperplasia.

4. Abdominal distension with red vent.

5. Exophthalmia with anaemia (reduction of Hb content in the blood).

6. Intestinal contents are yellow and watery or jelly, and contain excess mucus and usually free from food or faeces.

7. Systemic infection occurred lead to swollen of liver with petechial haemorrhages, ascites with blood clots in the visceral cavity. Also enlarged of spleen, kidney & gall bladder reported in infested fishes.

Treatment and control:

1. The infested fish treated with:

a. Metronidazole (flagyl) 5mg/1 liter for 3 hours and repeated every other day for three treatment (25mg/kg of body weight/day for 5 to 10 days).

b. Magnesium sulfate: 0.2-0.3% of the diet for 3 days.

c. Carbarsone: 0.2% of diet for 3 days.

2. Stress factors must be removed.

3. Good management of fish farm.

4. Disinfection of the bottom with quicklime.

5. Newly introduced fish must be held for 14-20 days in quarantine.

http://www.aun.edu.eg/developmentvet/fish diseases/5_3.htm

 

[Coryloach]

This one is also interesting, as it suggests spironucleus is not always pathogenic:...

In the ornamental fish industry, Spironucleus spp. cause severe infections in several economically important species including cichlids [5,24,40]. S. vortens has been proposed as the causative agent of holein-the-head (HITH) disease, a common condition generally associated with poor husbandry [24]. The disease is characterised by severe lesions on the head, lateral line and internally. HITH disease has been linked to systemic infection of S. vortens, with parasites recovered from internal organs and skin lesions of diseased fish [24].

It has been suggested that Spironucleus spp. are putative intestinal commensals, which become invasive in fish hosts with a compromised immune system or those which lack acquired immunity, under aquacultural conditions [39,41,42]. This is reflected in the observation that Spironucleus infections in wild fish are generally non-pathogenic (e.g. S. barkhanus in wild grayling [43] and S. torosa in wild gadids [28]). Stressful conditions sometimes observed in aquaculture, including poor water quality, temperature fluctuations and overcrowding, have thus been implicated as triggers of Spironucleus pathogenesis [39,41,44,45].

https://pdfs.semanticscholar.org/4436/b9633d411a5957943926ed730d7ca4594beb.pdf

 

[philipraposo1982]

I see this in discus a lot. A bump in the forehead ruptures and leaves a crater. A biologist friend of mine theorized this was likely a bacterial infection rupturing. He suggested it could be a secondary infection caused by clogged sensory pits, or sensory pits that are infected with hex/spiro.

This might sound crazy, but what I do for discus is net them, dip a Q-tip in hydrogen peroxide, and swab the wound really well to kill anything in it. Just don’t get it in his eyes. Then return the fish to a clean tank and do frequent water changes to keep things really clean until it heals. Sometimes it takes a few weeks to heal over.

I often recommend doing this in conjunction with a metro treatment. I use pure metronidazole powder at 400mg per 10 gallons which you really need a cheap gram scale for, otherwise it’s hard to know when you’re dosing enough.

I can definitely see the HITH scars on the fish in the picture. The best approach to keeping HITH away is frequent water changes and a good diet (maybe with some added vitamins).

So it sounds like you have actually dealt with this exact thing. Was your fish producing clear waste as well? Did you feed the metro or only dose the water? How long would you allow the peroxide to sit in the wound before replacing the fish to the tank?

This small hole first came about back in may 2017 and has been around since only to form a new pimple and rupture just days ago. If this is HITH, which i do believe it to be how in the world has it survived the metro and epson salt treatments i did? Why did the small hole never heal up? Why did his waste never fully normalize?

I am so confused...

I am not against treating the wound with peroxide directly but do have concerns regarding stressing him out during that process. Could this be counter productive?

I did perform a few meth blue dips before as well to help with the wound but it never did heal over.


I am also surprised to see you say you see hith scars on kai. Can you pint these out to me? A far as I am aware he has one hole in the middle of his head which he has had since may. I never seen other holes develop or anything that looks like old hith scars. Please point these out to me, maybe I am missing something.

The metro / Epson salt treatments must have done something as the hith never really advanced all these months.

A lot of cases I read about hith seems to advance fairly rapidly.

 

[RD.]

Cory - do a search on Spironucleus & my user ID, I have been posting about this parasite for years, probably hundreds of posts/threads on MFK alone. I am quite certain that I have read almost every paper on this subject at this point. I can tell you with 100% certainty that S. vortens, which is typically the sp. of parasite involved in cases of ornamental fish such as this, is treatable, even when in the blood stream, and/or organs. The problem is that treatment is not 100% successful, in all fish. But nothing is. There are numerous factors involved, including size/age and overall health of the fish in question. IMHO, this appears to be a chronic case, that thus far this fish just can't seem to shake.

 

[philipraposo1982]

How does the peroxide differ from the meth blue? Does one work better than the other? Do I apply the peroxide daily? How many days in a row?

 

[Coryloach]

For the record, there are alternative treatments for hex apart from metronidazole and epsom salts.
One can try meds based on dimetridazole or 2-amino-5-nitrothiazol as I already mentioned. They can be delivered as bath treatment which would be my choice if I am treating for HITH. Netting a fish causes a lot of stress....would be the last thing I'd do personally.

 

[ryansmith83]

So it sounds like you have actually dealt with this exact thing. Was your fish producing clear waste as well? Did you feed the metro or only dose the water? How long would you allow the peroxide to sit in the wound before replacing the fish to the tank?

This small hole first came about back in may 2017 and has been around since only to form a new pimple and rupture just days ago. If this is HITH, which i do believe it to be how in the world has it survived the metro and epson salt treatments i did? Why did the small hole never heal up? Why did his waste never fully normalize?

I am so confused...

I am not against treating the wound with peroxide directly but do have concerns regarding stressing him out during that process. Could this be counter productive?

I net fish all the time. It's stressful, but so is medicating them, and so are water changes, etc. If there's a chance of cleaning out the wounds and healing them, it's worth a shot. You swab them, let it sit for a second, and then put the fish back in the tank.

Clear feces can be lots of things. Usually hexamita creates white, stringy feces. If it's translucent, and there are no sign of eggs, I wonder if the fish is not eating and it's just sloughing mucus lining from its intestines. Sometimes gelatinous/slimy white or yellow discharge is a sign of internal bacterial inection, which I treat with kanamycin. I have actually treated with kanamycin and metronidazole simultaneously in discus. How long has it been since the fish ate?

I am also surprised to see you say you see hith scars on kai. Can you pint these out to me? A far as I am aware he has one hole in the middle of his head which he has had since may. I never seen other holes develop or anything that looks like old hith scars. Please point these out to me, maybe I am missing something.

I circled them all in red. Normal fish do not have pits this large in their face. These are either old scars of HITH or they're current HITH. It's hard to tell.

 

[philipraposo1982]

What you have circled are his normal sensory pits. At least I thought so.

He has always had them like this. I never suspected these were enlarged. I don't know how I missed that.

He eats everyday. He has a huge appetite.very very active, great coloration too.

 

[MrsE88]

Oh, wow. You know, I completely overlooked that his sensory pits are inlarged. I just compared them to Oliver’s and there is a big difference.
I wish I could help, but I’m very inexperienced(no experience really) with this. I’m following to learn though. I really hope you are able to find a treatment that’s works.