Holes in Head keep getting worse after metro. How else to treat HLLE?

[kaleideonegg]

Hi,

I've treated my fish with Metronidazole as he is developing lesions in his head. I've since finished treating with antibiotics as I ran the full course. However it appears to be getting worse around his nose hole - see pics.

What can I do now? I'm thinking of trying either promethyasul as I have some on hand, or formalin (have access to hospital supplies) as I have read that this can be good against protozoa. I assume that the culprit here is Spironucleus... he's not showing any other signs of HITH disease and behaviour is otherwise healthy.

Does anyone have any suggestions? Detailed/long winded story is below.

Thanks in advance, appreciate any replies..

I just want him to be able to start healing. Do these lesions heal up or if I can manage to get this under control will he be forever deformed?

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My Geo Braziliensis started getting lesions in the head approx 2.5 weeks ago. I first noticed 2 small pinhole sized holes and immediately put him in a hospital tank to allow me to salt the water and keep the water conditions high. The fish was and is not exhibiting any other signs of sickness but had been getting picked on a bit in its previous tank (stress).

Despite daily water changes the lesion got worse and more started forming, so after about a week I treated with Metronidazole (crushed tablet form) in the water (still maintaining salt levels) and food as he is still eating with gusto. I did treated each day for 10 days at approx 6mg/L with water changes every day. The holes seemed to slow in formation but still seemed to progress very slowly so I also put metro in his food, at an oral dosage of approximately 50mg/kg of body weight per day.

The 10 days of metro treatment finished up 2 days ago so I've just been trying to keep up my daily water changes, and have stopped replacing the salt. I've also taken to soaking his food in a liquid multivitamin rather than crushing up metronidazole with the food. I note that I did get some high vitamin feed for him about a week into the disease and have been feeding that ever since.

However today I notice that the lesions around his nose hole are spotted red and appear worse. I'm worried that the disease is still progressing. Should I try and treat with something else - if so what? I don't want to put him back on Metro due to resistance issues.


Tank stats:

2 foot tank, approx 60L
Ammonia: 0
Nitrite: 0
Nitrate: 0
pH: 7.6
temp: 27 C
inhabitants: 1 x braziliensis, approx 20cm (7yrs old).
fish behaviour: normal, eats normally, poo is normal & brown, stomach is not sunken.
water changes: approx 25% daily for the past 2.5 weeks


In the picture:
Scarring around the nostril was already present from a previous health issue, however its recently become spotted red and appears like it might start erroding again. Other holes have not been getting worse for the past week or so but I have recently stopped metro treatment so am hoping they don't get worse again.

 

[jlennon]

I can speak from experience HITH is fun. Metro + is my preferred method and has worked well for me over the past few years. I have an Oscar who has it and she has almost a complete recovery. I had been dosing with Malfix, Primafix, vitamin C, garlic, and metro.
I have reevaluated my approach and make a dry mix when I see signs appear. Here is the dry food recipe:
Using Dry Food To Make A Medicated Diet (this diet will typically float or sink depending on the type of dry feed you choose)

Start with 4 ounces (~1/4 lb, 113 g) of dry flake, granular or pelleted feed.

Place the dry feed in a suitable clean and dry container with a tight-fitting lid. (a wide mouth jelly jar works great)

Measure out 1 tablespoon of the dry medication. (BiFuran+™ or Metro+™)

Mix the dry feed and medication thoroughly by gently stirring or by closing the container and vigorously shaking contents.

Add exactly 1 ounce (~30mL) of 190ْ (190 proof) grain alcohol to the container while gently mixing with ingredients already inside.

Close the container and shake it vigorously to insure the feed and medication are intimately mixed.

Examine the mixture to make sure it has been well mixed and all ingredients have been wetted by the alcohol. DO NOT perform this procedure around an open flame or other source of ignition; alcohol fumes are highly explosive.

Open the container and allow the alcohol to evaporate completely. (this may take up to 24 hours) Gently heating the container by placing it in a container of hot water will accelerate the process. DO NOT do this around any open flame of any kind. DO NOT allow water to splash in to the mixture. DO NOT microwave the wet mixture.

Store the dry medicated feed in its container. Keep in a cool, dry place away from direct sunlight, high humidity or excessive heat. Keeping the container at room temperature will prevent moisture from condensing on the food.

DISCARD any food that acquires mold.



Feeding Your Medicated Food

Use the medicated feed you have just prepared in place of your usual diet.

Feed at least twice daily the amount your fish will completely consume within a few minutes. (no more than 5 minutes)

Always remove any uneaten food after the feeding period to eliminate the chances of it negatively impacting your fish’s environment.

Continue feeding for at least three days beyond the disappearance of all signs of the disease you initiated the treatment for. Stop feeding this food once a cure is affected, and NEVER use the medicated feed as a general food when disease treatment is not being attempted or as a preventative as this can result in development of drug resistant diseases that will be more difficult to cure.

NEVER USE PREPARED MEDICATED FOOD THAT IS MORE THAN 10 DAYS OLD – FRESHNESS IS A KEY TO SUCCESS. For this reason we suggest you do not mix more feed than you will use within a short period of time.

Feedings can be accompanied by bath or dip treatments using the same medication as you have incorporated in to the feed.

 

[jlennon]

If you look at my avator you will see my O with a spot on the nose which is left over from the first stages of HITH. depending on size of your fish you can also preform a dip with metro+. That is a lot of work but I have seen results. I work at a LFS which also uses Metro+ as a dip too.

Here is the Hikari link: http://uskoi.com/metro+.htm

I have also done a lot of reading in regards to vitamins. It is recommended to dose Vitamin C to larger species. You can either go towards Boyd VitaChem product:
http://www.chemi-pure.com/prd_am/product/idproduct=4

Or you can dose with Brightwell vitamin C:
http://brightwellaquatics.com/products/vitamarinc.php

What I have done is dosed a couple drops(est. 4 or 5) of Brightwell Vitamin C into my replacement water during a water change and dosed the VitaChem during feeding. I do a dry food every other day and a Bloodworm, mysis shrimp, and krill feeding every other feeding. If you go this way and you see an out break of algae cut your dosing of vitamins back.

 

[Henryng]

Can try octozin. Is really very good for this problem but even cure you need to monitor for some time cause it may come back again. The disease come from your tank. Remember you cannot treat your fish at the same time feed your fish. There is no ending to stop the problem. Fishes can withstand 1 week to a month without food.

 

[F1 VET]

Stress is a huge factor. Turn lites off and boost temp.

GL

#1 S. Vettel

 

[kaleideonegg]

Thanks all for the responses.. today I've noticed that the small holes behind his eye that you can just see in the picture have become much larger, and it's only been 1 day. Should I put him back on Metronidazole or is there a point at which you stop using the Metro?

jlennon, my main question was that I have already just finished treating him with Metro and if I start again now would it not just encourage resistance of the disease to the antibiotics?

The dry feed sounds like a good way to go, I was previously mashing up some food mixed with water and powdered tablets. However, how are you then controlling the dosage - eg how much of the drug is he actually getting?

Thanks again

 

[Kivstev]

Look into Clout as it has dimetronidazole which is more soluble in water than regular metro powder. I have come to the belief that regular metro powder in the water is fairly useless. You must get them to eat it or force feed them metro.

Edit: I should note that some of the Discus guys have had success with Metro at 2x or 3x normal dosages in the water.

 

[kaleideon]

I need more advice for this please... it is getting worse, see picture above.. there are a couple more lesions formed and the existing ones have gotten bigger and deeper.

Since my previous post I re-treated the fish, with an oral dosage of metronidazole (50mg/kg of body weight once per day) mixed in with frozen food.

I did this for a further 10 days. While treating the disease seems to remain the same. When the treatment is finished, (it's been about 2 weeks or more since the metro treatment finished) the holes start to very slowly get worse (more in number and existing ones get bigger).

The one on his head above his eye is now very deep and you can see a white bony looking thing in the bottom of the pit - skull maybe?

In any case I need to stop this from progressing so he can actually heal.

My question is, can I continue to treat with metronidazole for extended periods of time?

I estimate it would take months for him to start healing, so it would be on metro continuously for months. Would this not lead to kidney failure etc? I've read Metro is cumulatively toxic.

It seems like if I stop the metro, the disease gets worse. How long can I keep the metro up for? Given that I have already treated the fish twice already (10 days each time) with metro, why is it not working for me?

Are there any other options?? Please help.

 

[cbenner]

Your conditions in the Two foot tank sounds like you keep them well.Just nitrofurazone is a good antibiotic to stop the infection in the holes.What is the nitrate reading in the tank where he was originaly kept?

 

[kaleideon]

Thanks for the reply cbenner,

Nitrates were about 5-10ppm in the original tank, and he also got chased around a bit by the JD he was sharing the tank with. I belive the cause was initially stress but I isolated him as soon as I saw the first pin-prick sized hole. Unfortunately that's developed.

The existing holes don't seem to be getting infected, just larger and the number of holes are slowly increasing too. I think this is due to the original cause (hex? spironucleus? are these the same thing?) rather than secondary infection, what do you think? Any guesses on if the nitro would slow or stop the progression of the lesions forming?

Any ideas on if it's practical or recommended to put him back on metronidazole with no projected end date on the treatment (other than wounds have healed?)? I'm guesing this could take months.