Hole in the Head Hole in the Head (HITH)

This is less for help and more for information as I do have the situation under control at the moment. I will also use this to log the progress of the fish.

In my case this happened with a discus, however this IS common with Oscars and other large sloppy eating cichlids.

Here are my water parameters

Tank parameters:
PH - 6.4
KH - 35ppm
GH - 75ppm
Nitrate - 15ppm
Nitrite - 0
Ammonia - 0
Temp - 90

I noticed 2 days beginning treatment this one Wild Heckel with HITH. The fish continued eating and was mildly active so I followed the "Dont freak out" plan of treatment... waterchanges and wait.



I came home yesterday and when I went to feed it darted back to the back of the tank and refused to eat. I was feeding live food and with no avail... The pits in the head were larger and its forehead was swollen. It was time to remove the fish to QT and begin medication.

Med of choice: Metronidazole (sold as General Cure by API)

Day 1:
I did a double dose (which is OK and usually recommended on the first day or 2 of treatment to increase the chances of effectiveness) of Metro on a 5 gallon bucket.

I placed a heater set to 90 degrees (some reason the thermostat on it actually heated the water to around 92/93 which is good) and placed a small HOB filter on the bucket with no cartridge to circulate the water and aerate the water.

 

Day 2 (Morning):
This morning when observing the fish there was most if not all the blackworms I fed yesterday still moving at the bottom of the bucket. So it does not seem to be eating.

It was moving still, lighter in color (probably due to Discus try to match their background and environment) and not breathing hard. Fins were not clamped and other than the pits, it seems fairly healthy...

Plan for later is to waterchange the bucket 80% and re-dose the bucket with a 1.5x dose of Metro for today.

I will post pictures and progress after I get home and do the work to him/her (at around 6-7pm tonight)

 

Day 2 (Evening)
Water changed 90% on the bucket.... re-treated as mentioned with Metro 1.5x standard dose...

Here is what the head looks like today... I dont see too much improvement yet...

 

Not really... well kind of... Oscars, Discus and well... many sloppy eating Cichlids... I had this before with an Oscar... I think I can get this fixed...

 

cooltow - I agree with you on your thought about HITH/HLLE. However I also believe it is not HITH/HLLE that actually causes the death in the fish, its the secondary infections (Heximita) There is little proof that Heximita is actually the cause of HITH. However in over 95% of cases where the site was swabbed, there HAS been some amount of Heximita present (sometimes though not enough to cause any real illness)

In the studies on Discus, the best treatment seems to be Metronidazole/(Flagyl in some countries). This along with an elevated temp (similar to us getting a fever) seems to be fairly successful in the treatment of HLLE for all fishes that get it including Oscars, Discus and Angelfish.

Poor water quality is USUALLY the cause of the disease however that is not the case in my example. ANY stressor to a captive fish is capable of triggering this disease and my case I believe it was a social imbalance in the pecking order of my "small" ecosystem that I created. In the wild Discus have MILLIONS of gallons to move throughout and THOUSANDS of fish in the shoals. In my ecosystem there were 6 and only 125 gallons. Mind you that I do have wilds and it is the WILDS that got sick NOT my domesticated ones. Adaptation for many animals from a wild life where predators are common place and life is stabilized by safety in numbers to an environment that is controlled and on a smaller scale I would imagine is difficult and stressful on the fish. Not to include the capture/transport of the animal.

In conclusion there are MANY thoughts to the cause of Hole in the Head/Lateral Line Erosion in fish, whether it be Heximita causing it, a vitamin deficiency, stress weakening the immune system or the tens of other theories.... one thing is certain, if left untreated HITH/HLLE becomes fatal in fish that come down with it usually due to Heximita infections. The BEST treatment for that is Metro/Flagyl which is sold over-the-counter in the US and also sold as a prescription by vets in many other countries.


Jrow - I usually prefer handling the fish with my hands as it is less stressful than a net on my fish. The net for me has caused many problems and in a small space like the bucket it would cause undue stress to them. I have 2 nets and my large one BARELY fits in the bucket. You can see that the fish that is sick is larger than my hand so my smaller net is useless for it.

Everyone Else - Thanks I hope it pulls through too. It is still doing well today.

Day 3 (Morning)
I added last night the other Wild that was not eating. It seemed to be getting rather thin and with the strong possibility of Heximita in the tank from the one with HITH, I figured I would do the same treatment on this one IN CASE it has INTERNAL HEXIMITA. There is a STRONG chance it does.

None-the-less it has been in the tank now for almost 24 hours and the food (live blackworms) that was in the bottom of the bucket uneaten from the other day is now all gone. I fed them both again. Coloring on both seems well too. Again this COULD be a mis-judgment because as I said Wild Discus and even many domestics try to blend to their surroundings (white = lighter coloring)

I pulled the HITH patient out today again with my hand a bit and the redness on the site has came down and is now more of a pinkish color (seems to be healing)

 

Agreed but neither seem to be eating well enough... They ate blackworms but not the Medicated FBW I made....

 

Day 4 (Morning)
I kind of laughed this morning because both of the discus in the bucket are fairly active and even swimming mid-top level in the bucket and not backed up to the wall in the lower part of the bucket at the bottom. This would be the first time I have ever had had a fish live in a bucket for more than a day (but I never had a filter on a bucket)

Yesterday I purchased a container of Metro Powder from my LFS. Upon looking close to the ingredients in the API General Cure it contains: 250mg Metronidazole and 75mg Praziquantel. So additionally it treats flukes. I just got plain Metronidazole as its 1/2 the price for a large container of it this way which will treat larger amounts. As mentioned in another thread I like to keep Metro at all times "just in case"

My plan from here:
1 - One more 90% WC and another hard dose of Metro
2 - After about 6-8 hours (max effectiveness for Metro) release both fish back into the main tank.
3 - Medicate FBW and feed to the whole tank for several days. (I plan on the oral meds this way as it will treat it in case any in the main tank have internal Hex. Also the 2 sick ones will see the other ones eating and hopefully will take back to eating... kind of like "follow the leader"
4 - I will continue my 50% WC that I have done for the past 3 days on my display (side note, the frequent waterchanges on the 125 had another interesting side effect: The Ovipositors of almost all of the Discus are out and I have VERY VERY strong pairing behavior in 4 fish or 2 pairs.... I have the 2 "pairs" cleaning sites together... oddly enough, my 2 avitar fish I have had (the yellow/red one and my current heckel avitar) are 1 of the 2 pairs. The Mayan Jade and "Chief" are another possible one...)

Todays progress on the HITH patient, the head looks even better IMO:

 

I ended treatment and re-introduced them back into the display tank. I fed the tank live blackworms and these 2 did not eat... hopefully they will eat on a future feeding soon.

Due to the new territories they have kept stumbling across the pairs territory with a hard thump into their sides.

 

Well... I removed the pair from the 125 and put them in my 30 a few minutes ago... the 125 is now calm again with less aggression!

That should help the 2 sick ones again... who knows I may get another pair too