Parasite? Bacteria? Overnight Development on Tangs in Quarantine

alg · May 27, 2015

We have had two tangs (Monrovia and Ringtail) in a 55 gallon QT tank running Cupramine for a little over three weeks -- very happy and healthy. They were with two triggerfish and a gold rim achilles and some chromis. Two days ago we noticed they were starting to get picked on and had some scratches on their sides, so we decided to move them to another system, which was not running Cupramine or anything else. That system has some coral and two other fish that went through quarantine.

Overnight, these two tangs developed large white discolored patches and heavy breathing. We immediately moved them to a third system running Cupramine, Prazipro, and Furan-2 (we had a fish come in with flukes which wiped out half that quarantine system. we are aerating that tank heavily to compensate for the combo meds). Unfortunately the fish have continued to deteriorate rapidly: their fins are eroding and look brittle, the white patches are expanding on both sides of the fish, one fish had reddish patches within the white patch last night, but now it seems as if the skin is sloughing off.

Since they did have some cuts, we assumed it was bacterial. The other fish in the tank where they developed symptoms are all fine; the cuts may have just exposed them to infection. But I'd think that the presence of the Furan-2 would at least halt the onset if it were bacterial? Also, will a bacterial infection take hold that quickly? Will it cause these symptoms of rapid fin erosion / white patches / skin sloughing off? The rapidity makes me think parasite -- like, brooklynella. Also the shedding of the skin.

Another interesting factor is: we had a pair of triggerfish come in with strange white patches a few weeks ago (thread here: http://reef2reef.com/threads/bizarre-white-patches-on-new-crosshatch-trigger.200336/#post-2288053). These are the same triggers that were in the tank with these tangs. We treated the triggers in Cupramine -- nothing else -- and the patches cleared up slowly, but it's not definitive if the copper helped or it just cleared on its own. LiveAquaria Divers Den INSISTED the fish looked perfectly fine when they sent it to us. We thought it was impossible for something like that to develop overnight, but it did on these tangs! Could there be something suppressed by the Cupramine that was able to manifest when the fish were transferred to a non-copper tank?

4FordFamily · May 27, 2015

Also looks like it could be velvet or flukes --- flukes often tear up the fins, and velvet will too - but this is generally the worst in the front half of the fish.

I am at a loss, [HASHTAG]#HumbleFish[/HASHTAG] is probably your best bet.

Humblefish · May 27, 2015

It does look like a nasty bacterial infection, but the skin sloughing off also makes me think brook.

This is what I would do in your shoes; treat them with this combination of meds: Furan-2, Kanaplex and metronidazole (exs. Seachem MetroPlex or Metro-MS).

Adding Kanaplex to the mix will widen the antibiotic spectrum. Metro is an alternative treatment for brook. If this mix doesn't get the job done, then your next best bet would be to treat with formalin (for brook).

Humblefish · May 27, 2015

You can safely use all three of the above in conjunction ... but do be sure to increase gas exchange exponentially to compensate for decreased available O2.

alg · May 27, 2015

Oh, yep, I forgot we do have Metro in that system too. I thought about adding Kanaplex but, yeah, was already concerned about O2 levels -- tricky balance of treating the sick fish and not making the non-sick fish worse...

Pretty sure it can't be velvet with all the Cupramine, but flukes might be a possibility. We did have a fluke infestation which we treated with Prazipro, it's cleared up in the QT tank now and we are just continuing treatment to ensure it doesn't come back. It's possible that the Non-Copper tank somehow got some flukes in it; we are pretty careful about not mixing tools between tanks, but it's always possible. The flukes definitely presented with fin erosion, but we didn't see any of the skin sloughing with the flukes, or such a rapid onset. I suppose the scrapes might have presented an easier entry point accelerating the infestation. I kind of hope it's flukes with a secondary infection, because then we might have a chance to contain / cure it. If it's brook or something similar, we'll be in trouble. If it were brook though, I'd kind of expect the fish to be dead by now (we are at the two day mark). I'd also kind of expect our clowns in that system to be showing symptoms, although from what I've read it does seem to affect fish randomly.

We sent off a sample previously from the triggerfish but we were sending it internationally and I guess it got damaged in transit so we didn't get any definitive results. We've ordered a microscope so we can try to learn to ID some things ourselves.

I think if the combo antibiotics don't seem to have any effect after a few days, we may do a complete drain/sterilization of that tank and then re-start treatment with Chloroquine Phosphate. It's kind of ironic when you have to quarantine your quarantine system! Previously we'd always used copper and occasionally antibiotics or metro in the food and never had issues, but lately it seems like copper doesn't cut it. We're preparing to put in a new 750 reef tank so are quarantining everything, but have had more issues than ever. At least we're having these issues BEFORE they go in the DT... and not in the tank with the gem!

alg · May 27, 2015

(Also, thanks very much for the responses!! Really helps when you're questioning your sanity poring over blurry pictures of infected fish...haha)

Humblefish · May 27, 2015

You could quickly confirm/rule out the possibility of flukes just by doing a 5 min FW dip. You sound like one who already has experience ... but just in case I've included instructions below.

Freshwater Dip: Provides temporary relief for Brooklynella, Flukes, Marine Velvet disease (Amyloodinium); possibly even Ich & Uronema marinum (both unproven). Can be used to confirm the presence of Flukes.

How To Treat - Fill a bucket with RODI water, and use a heater to match the temperature to the water the fish is coming from. Aerate the water heavily for at least 30 minutes prior to doing the dip, then discontinue aeration while performing the dip. Fish aren’t overly pH sensitive for short durations like this, but you can squirt a little tank water into the dip just before the fish goes in to help bring it up.

Place the fish in the freshwater (FW) dip and observe closely. It is not unusual for them to freak out a little at first. Also, tangs are notorious for “playing dead” during a FW dip. The important thing is to watch their gills; they should be breathing heavily at all times during the dip. If breathing slows, it’s time to exit the dip. Dip the fish for no longer than 5 minutes. Multiple dips may be done, but it’s important to give your fish a day to recuperate in-between dips.

For flukes, use a dark (preferably black) bucket so you can see if tiny white worms fall out of the fish (especially out of the gills) at around the 3-4 minute mark. The worms will settle to the bottom, so you can use a flashlight to look for them there as well.

Pros - Provides temporary relief for a wide range of diseases in a chemical free environment. Can “buy you more time” until a proper treatment can be done.

Cons/Side Effects - Not a permanent “fix” for any disease, as FW dips are not potent enough to eradicate all of the parasites/worms afflicting the fish. Some fish can have an adverse reaction to a FW dip by appearing unable to maintain their equilibrium once returned to the aquarium. If this happens, hold the fish upright (using latex, nitrile or rubber gloves), and gently glide him through the water (to get saltwater flowing through the gills again). It is also a good idea to place the fish in an acclimation box until he appears “normal”.

alg · May 28, 2015

Quick update:

Liked the idea of a freshwater dip but was hesitant to do it on the injured fish, so dipped one of the purple firefish from the same system instead. Did not see anything come out of the gills, but did see some small whitish blob-specks on the bottom of the bowl after taking the fish out and leaving the bowl for about 15 minutes. Could have been suspended in the water and settled after some time... hard to say if it was flukes. Having a fish expert come over tomorrow so will try a dip again on another firefish and see what he thinks.

Have been continuing the regimen of Furan-2 with Metronidazole and Praziquantel, and the addition of Kanamycin. Performed an 85% water change today to eliminate the majority of the copper and stay ahead of ammonia. Want to put all the fish through a CP regimen eventually and copper did not seem to be doing anything to help: one less medication in the water means a little more breathing room. After some hesitation I also added a dose of Stress Coat with the hope that it would help promote a protective slime coat for the wounds -- only worry was any potential interaction with the residual cupramine or interference with antibiotics. Not a lot of information out there on that.

The Monrovia tang is still swimming, but it looks worse than I thought it was possible for a fish to look and still be alive. His pectoral fins on both sides are almost completely eroded. His caudal fin is almost completely eroded. His white patches have turned into what look like open wounds: the skin has mostly come off and the areas now looks red and inflamed. It seems to continually swim around the tank in the hope that it will find some relief in the flow. I'm not sure how it keeps going.

The Ringtail, which was the better off of the two from the start, seems to be holding steady. He has some erosion of his left pectoral fin and caudal fin, but it does not seem to be getting worse over the past two days. His white patch has not gone red. Unlike the Monrovia, he seems to prefer to sit in one spot and rest.

This is from early this morning:

And this is from this evening:

Will keep fingers crossed and keep up the antibiotic regimen.

4FordFamily · May 28, 2015

Actually that reminds me of uronemia (so) that chromis get frequently... [HASHTAG]#humblefish[/HASHTAG] what do you think?

Humblefish · May 28, 2015

3FordFamily said:
Actually that reminds me of uronemia (so) that chromis get frequently... [HASHTAG]#humblefish[/HASHTAG] what do you think?

I've never seen uronema cause that large of a "sore" before. But at this point, anything is possible. My money is on a gram negative bacterial infection. Very difficult to treat... even with antibiotics.

Humblefish · May 28, 2015

@alg Any way you can get a skin scrape to someone with a scope and knows what to look for?

alg · May 29, 2015

Yep the redness also initially made me think uronema... which sent me on a mostly fruitless scavenger hunt for any creditable information about it.

The only thing that seemed consistent about uronema was that the fish died very rapidly after symptoms appeared, and the infected fish seem like they tend to display signs of "flashing," which these guys never did. We did have them with some Chromis though, and they seem to be common vectors...

Both fish actually seem a little bit better this morning. The Ringtail nibbled on a few pieces of mysis (soaked in all kinds of good vitamins and meds), so I have high hopes for that one. The Monrovia hasn't eaten yet, but is still swimming strong and has started to develop what looks kind of like either a white slime coat or new skin over the large red patch. I give him maybe 50/50 a this point. He was pretty fat to start with so he should be able to survive a few days without eating, and his breathing is normal, but gosh he's in bad shape!

I was just looking into where I could send a sample -- found a great website called fishvets.org where you can find local vets who work with fish specifically. Have reached out to a couple and hoping one will be able to help out with analyzing a scrape or a water sample.

Thanks again for the great advice you guys!

Humblefish · May 29, 2015

Below is what I know about uronema. Because it is a free living parasite, once it makes it's way into a tank it is essentially there until you sterilize that tank. Going fallow WILL NOT eradicate it.

Yet another reason to QT.

Uronema marinum:

Symptoms - These are the red sores often seen on chromis damsels. The disease seems mostly confined to damsels and clownfish, but I have seen some exceptions to that.

Treatment options - This is a very difficult disease to treat. Possible treatment options include: Metronidazole (ex. Seachem MetroPlex), acriflavine (ex.Acriflavine-MS), Chloroquine phosphate and copper. The problem is the fish can never be returned to the infected tank from which it came. Uronema is a “free living” parasite which does not require a fish host. So, going fallow will not eradicate it. Most fish seem protected from it via their natural immune system; but for some reason, chromis and some other fish are not always afforded this protection. Once a tank has Uronema, it must be assumed that the disease can survive in there almost indefinitely.

Formalin bath or freshwater dip may provide temporary relief for Uronema.

4FordFamily · May 29, 2015

Geez! I hope they pull through. The white mucous coat just eerily reminds me of the late stages of velvet... But you said your fish are in copper right?

alg · Jun 1, 2015

Good news!

Saturday (five days after symptom onset), the Monrovia tang began eating again. His wound was still reddish, but was beginning to show signs of healing around the edges.

Sunday and today, both fish are eating like normal -- picking at the rocks for algae and taking mysis (soaked with nutrients and meds). The Ringtail's lesion has decreased by about 50% and its fins show signs of beginning to grow back already. The Monrovia's lesion this morning has only a small reddish portion: it has definitely begun to regrown skin over most areas. It still has some trouble swimming because of the severe fin erosion, but now seems to be able to hover in one spot if it needs to (no longer constantly swimming in circles around the tank).

We're still not sure what this was. I found a fish vet in the area, but she will be out of town for a week. She said she will get in touch when she is back and come to do some investigation, but by then whatever caused it will probably (hopefully!!) be gone.

Whatever it was seems to have responded to one of the medications in the water. In case anyone else encounters something similar and wants to replicate those medications, here are the dosages we used for a ~160 gallon system (180 gallon by measured volume minus 20 gallon for filter/rock/etc):

Cupramine -- .5 ppm first two days, lowered to .25 ppm after 3rd day (this was residual from prior dosing)
Furan-2 -- 16 packets daily (1 packet per 10 gal)
Kanamycin -- 75 mg/l to start with 50 mg/l the following two days
General Cure (Metronidazole + Praziquantel) -- 16 packets on day 1, another 16 on day 3
Stress Coat -- 16 tsp (1tsp/10gal)

We did an 80% water change on the third day. We also had the skimmer overflowing with the top off to provide additional aeration, as well as a couple of bubblers in different sub-tanks.