I most often encounter this in potential breeders, who at times are in a stressful situation as pairs are forming, or in dime to nickel size angels, who are in no more of a stressful situation than their tankmates, but will hide & stop eating. Colin may be right that my eye catches this right off, as with potential breeders there is a sort of truce during feeding time, and smaller ones crowd the front of the tank.

The slow eater with the breeders will get target fed, and if there is any hesitation to eat they get pulled & medicated. The same applies to juvies that don't follow the herd, they should all be practically jumping out of the tank to eat.

Internal protozoans rarely show up as HITH in angels, I have yet to see it, other breeders I know have yet to see it. I don't breed angels for a living, I would starve to death, for a professional opinion from someone who does breed for a living you may want to check this out; http://www.angelsplus.com/ArticleCare3.htm

When you add in the hiding, as well as the feces, you may have a case of HITH, with the protozoans as a secondary problem. Stress is a major contributing factor, the aggressiveness received would certainly qualify. The thing I can't see, which are major contributing factors to HITH are poor water quality, and a poor diet. It seems that you are feeding a balanced diet, as well as keeping the maintenance up.

The availability of meds in the UK is something I personally think is a terrible situation. You may do well to contact emmsy, as I'm sure she deals with meds on a very regular basis.

As far as it spreading to other fish, I've never had a whole tank, or even part of a tank, of angels come down with symptoms of internal protozoans at the same time. It is from what I have experienced either a single older fish, or one or perhaps two younger fish.

You may have a case of HITH, though with the quality of care I am tending to doubt this. You also may have a case of protozoans manifesting as HITH, while not seen by me, or other angel enthusiasts, is far from probable. This does not mean it is impossible, and really interests me, as I'm sure it will other aquarists.

Good morning everyone, and wow, what a debate first thing in the morning. I haven't even had my coffee yet, and the words on the screen are a little hazey.
Firstly, can I say that people are throwing the word Metronidazole around as if it is asprin. Metronidazole is a seriously potent concoction, and must be dosed correctly. In is raw form, it is used in dental treatment in humans, and if you take alcohol while taking it, a week long stay in hospital will follow.
Anyway, yes Colin, I'm swaying more to your diagnosis, although I would like to see a scraping under the microscope to be sure.

A paper that was written by Fred Godall & Dougall Stewart springs to mind.

Here is the link to save me writing it all out, Section (4) will give the treatment

http://www.ukdiscus.co.uk/spironucleus.htm

Now, Metronidazole soaked meds do exist, but I'm afraid thats where my weak point is. I am not aware of any brands that you can buy off the shelf here in the UK,although I am sure there will be one. Because I am a vet, I have access to the "Good stuff" all the time, so my knowledge of what is on the shelf is somewhat limited.

Metronidazole is available from a vet, although it is a prescribed drug, so a visit to the vet is a must. However, print out and take your photos to the vet, and print out this thread to show you have researched it, and I'm sure the vet will prescribe a small amount to soak in the food.

Hope this helps


Edit: Qtank the angel first to observe the treatment


Emma

This post has been edited by emmsy: Apr 29 2008, 05:38 AM

Thank you for responding. A scraping is the only way to come close to a correct diagnosis, as would a fecal smear. I have that UK Discus article saved on disk somewhere, at 1am I'm not too ambitious about digging it out.

Part of the original research that is referenced can be found here, and does show a picture of an angel with advanced HITH; http://www.int-res.com/articles/dao/45/d045p197.pdf

I see they base some of their dietary recommendations on Untergasser's book, which anyone interested in the diagnosis of fish diseases should get their hands on. Another one, more oriented towards pharmacology, is Herwig's book.

I'm wondering if in this situation it isn't a chicken or egg thing, in that the HITH may have come first, with the protizoa issue a secondary situation. Perhaps you have seen cases of HITH where the water quality & diet are not a problem, I have yet to see or hear of that. Once again, I do not see it as being impossible, as I haven't seen every fish, in every situation. Being a world wide forum, there is no way anyone here ever could, but does expose us all to situations we normally would not be aware of locally.

Interesting stuff. Bedtime for me.

Oh for sure. I have the original paper written in my files somewhere. My thirst for knowledge is immense. Thats why I joined this forum. Somethings I know, and others I have to research like the rest of you. I have a copy of the Untergasser's book, and have alot of articles commited to memory. How sad is that? and maybe the reason I haven't had a boyfriend in 3 years LOL.

This post has been edited by emmsy: Apr 29 2008, 06:37 AM

Thank you again Tolak and Emmsy for your contribution, suggestions and advice.

I have decided to take my fish to the vet after all. The practice is http://www.cjhall-vets.co.uk/services.htm#Fish and the vet htttp://www.cjhall-vets.co.uk/staff.asp and they specialise in exotics, fish etc.
I'm very lucky that they are only around the corner from me.

So "Angel" is going in on Saturday to be examined !!!
I see they even have a special "fish operating table"

I will report back when I have further information and feedback.

This post has been edited by Bloo: Apr 29 2008, 12:04 PM

yeah definatley get to the vet

just to share my experiences with HITH, I got it in my oscar a while back and managed to treat it. Got metronidazole from my vet, Tolak had advised me at the time about it and I believe he (and others in the USA) often get it in a powder form, for me it came in a liquid suspension. The vet advised me to give the fish 'baths' in it diluted with tank water for an hr a day which i did. when he was in his bath i did a 50% water change (every day for about 10 days). he was quite distressed by the treatment and i was worried about him on a few occasions but he did pull through. I also got some vitamin supplements, dissolved them in a little water then soaked his food in it so he was getting loads of healthy stuff into his immune system to help fight it.

really with fish meds it's quite bad in the UK, I'm fairly lucky, while my vet has no real fishy knowledge he's happy to get me prescriptions. I just have to take some pics of the fish and take them to him with one of my fishy health books detailing the problem and what med to get, he'll cross check it in his fishy book and give me the med. I'm sure with a specialist fish vet you'll be fine.

Oh, you are laughing mate. With a fish speciality vet just around the corner, it would be a shame not to go. God, I can't beleive I'm on the forum in my lunch hour too

Good luck mate

Emma

This post has been edited by emmsy: Apr 29 2008, 12:24 PM

Emma, is that dedication, passion or obsession? All very fine line I'm sure!
I used to work as a veterinary nurse / technician btw and loved it. Pity there's no money in it for me and I couldn't live my life as an eternal penniless student!
But I'm still involved on the side lines working (in my free time) for a specialised pet sitting company which only employs vet nurses to look after & medicate ill pets in their own home whilst owners are away on holiday.

This post has been edited by Bloo: Apr 29 2008, 12:39 PM

Oh, for me, it's not a fine line at all. It is an obsession. end of story.

Vet nurses are the backbone of the vet profession IMHO, but wages compare to a pot washer in the catering trade, so no wonder so many people leave.
Can't you get an appointment till saturday? or is it a money issue? Most vets will do some sort of repayment terms if you are struggling

I knew my path was mapped out for me for a tough time, when she gave me a name that, when abbreviated to Emmsy, is actually longer than my real name Emma

lol!
No, I could go sooner but work hours against surgery hours don't allow unfortunately and I have crazy meeting schedules over the next few days. And as the fish has had it for a few weeks now I'm sure a few more days are not going to make a major difference. I know I should have spotted this sooner and done something about it sooner, but I thought it might be something that would respond to Melafix (as it didn't look like a parasite or anything I knew). And as I saw no signs of it spreading on the fish itself (multiply) or spread to other fish, I kept hoping it would heal by itself or respond to Melafix.

Obviously not....

I am gonna start a thread tonight to discuss this exact point (If Colin or Wilder doesn't do it first), about timescale and asking for help with treatment. I think a good debate is in order.

Goota go

Emma

Nice idea, I'll add my two cents in a bit. Excellent idea with the vet, a vet with experience in aquatics is hard to find, consider yourself lucky to have one so close.

As far as timescale, I sent a little e-mail to Steve at AngelsPlus;

I was wondering if you could do me a little
favor &
take a look at the pics of this angel;
http://www.fishforums.net/content/forum/240789/Ang
elfish-Problem-What-Is-This-Protrusion-postule-/

I've seen larger cichlids with HITH, as well as
the
scarring from HITH after it has been cured. In
none
of the cases I have run across has there been
white protrusions, nor has it healed on its own
without some consistent large water changes, and a
change in diet.

In the cases of angels with internal protozoans
I've
treated I have yet to see it progress th HITH.
What
throws me with this one is the healthy maintenance
&
water conditions that have been maintained. These
two
are the main causes of HITH, and with the fish
just
starting to show signs of internal protozoa
problems I
am bewildered as to how the external HITH could
progress, if that is what it is.

Just something I thought might be of interest,
you
can post on that board if you like, or just
respond to
me. This is basically for my personal knowledge,
as I
have never seen an angel come down with HITH when
the
tank & diet are maintained.

Thanks!

John


His response;

Hi John,

Yes, that is hole in the head. Classic look. It
always starts with protruding puss. If you r's
didn't, it was not HITH or you simply missed it.
That stage can be very short - sometimes only a
day or two. The hole is what is left when the puss
heals. It's also quite common in angelfish. The
cause is unknown, but I believe something as
simple as long-term overfeeding can do it. If the
tank is overcrowded, it doesn't even take
overfeeding. Simply correcting the over-population
or reducing the amount of feed will work
everytime, if that caused the problem.

Hope that helps.

Steve Rybicki
Angels Plus http://www.angelsplus.com/
P.O. Box 886
Olean NY 14760
716-372-5273
Fax 866-809-8537 (toll-free


One more vote for HITH. What still bewilders me is the lack of dietary & water condition causes, which Steve has mentioned. I'm very interested to see what this vet says as a hands on diagnosis is much more definitive.

I also called National Fish Pharmacy's help line this afternoon, and plan on e-mailing them a link to this topic in a bit. I'm interested to see what they come up with as well.

***Edit to Add***

National Fish Pharmacy got back to me;

Hi John,

HITH (hole in the head) is a protozoa that causes Hexamita. In early stages, this protozoa will send up what I call cones (because sometimes they look hollow, or have a hole down the middle of them), before they turn into the actual "hole in the head" or advanced stage of pathogen that they become.

This disease and well as the common strains of Ich are starting to mutate on us. This is due mainly to global pollution and improper use of medications.

I would try this drug, and only this drug to see if it works: Quinine Sulfate. Quinine Hydrochloride will not be effective. Metronidazole will not work either.

Best Regards,

Dr. Brian G. Aukes; PhD
c/o National Fish Pharmaceuticals
http://www.nationalfishpharm.com

Tolak

The fish is old and could well be suffering from other problems, worms, gill flukes, etc. It doesn't take much to stress an old fish and if it is suffering from other problems then the combination is what brought it on.

Interesting to know that other people now believe common fish diseases are mutating and developing resistant strains. Also that metronidazole no longer works. I suppose it depends on what strain is affecting the fish as to whether or not it will work on them. Otherwise it's a vet job for some Quinine. That should stop the fish catching malaria too

Quinine Sulfate causes pH elevation in intracellular organelles of parasites, so I can see where he is coming from whith this cause of treatment. I was suprised to hear him say that Metronidazole will not work. I wonder the reasons.

Emma

I am bowled over by the response. Tolak, thank you for going out of your way to help identifying this. I really appreciate it and I've certainly gained knowledge.
Unfortunately I don't have much time to read and respond indepth as I'm about to go into a meeting (just drinking a cup of tea in a 5 minute gap!)

I will respond later tonight in more detail.

By all means e-mail them; nationalfishpharm@yahoo.com You would know the technicalities as far as how meds operate, and could perhaps explain it in layman's terms to those of us with very little formal education in pharmaceuticals.

Hi All. Just a quick update.
I took the fish along to the vet on Saturday. But this time, the postules have broken off and only a couple of tiny white spots remained on the head, above they eye. But I can actually see indentations where the previous postules were.
Anyway, the vet doesn't have quinine sulfate (says it's outdated to use for HITH?!). And the fish was prescribed with Flagyl (Metronidozole) to soak live food in and then feed once a day for 5 days.
In conjunction, Tririssen injectable every 2 days. I've never injected a fish before (a host of other animals yes, but fish never) but it all seems to be going well.

The 2 Angel fish are seperated in their own 10 gallon bare filtered/heated tank. Obviously this is only short term and they'll return to the 120 gallon tank once it's cleared up.
So we shall see how it goes I guess.
I will update as we progress.