A suggestion to treat hole in the head

[pcsb23]

HITH is one of those "diseases" which I think can be attributed to many factors. I think that suggesting flagellates as the only or even primary cause is somewhat too simplistic at best. It would be nice if everything in fish health was black and white, sadly it just isn't.

Also, just to be pedantic, the flagellate in question in discus is almost certainly spironucleus vortens and not hexamita, though to all intents and purposes they are treated the same and have the same effect etc ...

There are plenty of examples where people have examined the pits that occur with HITH and found absolutely no evidence of flagellates, and I'm sure there will be cases where evidence has been found. My own view on this is that it is too easy to jump to a conclusion based on this. When we factor in Untergasser's findings re dietary deficiencies of calcium, vitamin D and phosphorous (iirc) then the situation becomes even less definitive. Incidentally I believe that spiro/hex reproduces by fission, and am not aware of any larval stage, though I may be wrong.

I have examined the fibrous matter that comes from some of the pits created in discus when they exhibit HITH, I have never found any evidence of any parasite in there, but that in and of itself doesn't mean they weren't there in other cases. Quite simply I haven't looked at a large enough sample size to draw any conclusions.

In my experience HITH occurs over a prolonged time too, it isn't a sudden manifestation. Likewise the healing/closing of the pits that typify it also take time. Martin's experience of seeing them close in 4 days is exceptional, whether that can be put down to using amoxicillin or not, I don't know.

I believe that anything which takes away nutrients or impairs the fishes ability to properly use these nutrients can be a contributing factor to the formation of HITH. This could be an imbalance of minerals, but would more likely be a lack of trace elements that facilitate the fish using the vitamins and minerals. It could be a parasite infection such as worms or flagellates (though we tend to think of flagellates as a bacterial infection). It could be that the fish has become stressed and that has interfered with it's ability to use the nutrients and/or allowed the parasites to get the upper hand as it were. It could also be environmental or husbandry related, i.e. we are not maintain them properly.

To routinely use metro as the de-facto treatment is I think wrong. More harm is caused through the persistent over sue of meds than just about anything else in the hobby other than poor husbandry. I class the over sue of meds as poor husbandry though. Prevention is better than cure, in many cases I am confident that the fish would heal just as well with improved care.

[mikediscus]

It has always been my understanding that the mode of reproduction for the flagellate hexamita was binary fission. I am not aware of any larval form that you speak of. Are you aware of any conclusive publication or online article that shows my understanding is incorrect?

If the progression of the hexamita was so severe as stated in the above synopsis, it seems highly unlikely that any treatment would be successful.

-Rick

Dr Noga, EJ. Fish Disease Diagnosis and Treatment. Iowa State University Press; 2000.There is no such thing that suggest that your understanding is incorrect. I believe that the professional Doctors and scientists spend years in studying and research about this issue and form their own opinion of the issue and published books and article so that we hobbyist have a better understanding of the issue. In another article that I read a long time ago from: Dr. Gary Aukes; Pharm D, Dr. Brian Aukes; PhD. and I quote "The internal form of Hexamita are flagellated protozoans found in the gastrointestinal tract of a wide variety of fishes. They frequently infect discus. Spironucleus may be a distinct organism from Hexamita, as it is longer and possibly more sinuous, but for practical purposes, both organisms appear to cause similar clinical responses. These parasitic protozoa are very motile. The flagella are usually not easily seen. Many times infections are not apparent. The disease is characterized by poor condition, weight loss and death. The fish may also show excessive nervousness, turn dark in color, and hide in the aquarium". My point is that every Doctors have their own theory and as a hobbyist I read those articles to have a general knowledge about the issue (not claiming that I am an expert). So when I am faced with the issue, I try different suggestion from the expert and stick with the one that works best for my Discus. I believe these kind of forum is good for hobbyist to share their hand on experiences on different issue, not claiming to be an expert.
In conclusion I believe that every living being that live on this earth has certain common needs to survive on this earth, just like human we depend on good quality of air,water food and land to survive and fish they need good quality air water and food to survive too. So when the fish has issue we got to check the basic of their survival that is water air and food. If we can maintain those criteria in an aquarium we will not have any issue on the fish's diseases.

[pcsb23]

Dr Noga, EJ. Fish Disease Diagnosis and Treatment. Iowa State University Press; 2000.There is no such thing that suggest that your understanding is incorrect. I believe that the professional Doctors and scientists spend years in studying and research about this issue and form their own opinion of the issue and published books and article so that we hobbyist have a better understanding of the issue. In another article that I read a long time ago from: Dr. Gary Aukes; Pharm D, Dr. Brian Aukes; PhD. and I quote "The internal form of Hexamita are flagellated protozoans found in the gastrointestinal tract of a wide variety of fishes. They frequently infect discus. Spironucleus may be a distinct organism from Hexamita, as it is longer and possibly more sinuous, but for practical purposes, both organisms appear to cause similar clinical responses. These parasitic protozoa are very motile. The flagella are usually not easily seen. Many times infections are not apparent. The disease is characterized by poor condition, weight loss and death. The fish may also show excessive nervousness, turn dark in color, and hide in the aquarium". My point is that every Doctors have their own theory and as a hobbyist I read those articles to have a general knowledge about the issue (not claiming that I am an expert). So when I am faced with the issue, I try different suggestion from the expert and stick with the one that works best for my Discus. I believe these kind of forum is good for hobbyist to share their hand on experiences on different issue, not claiming to be an expert.
In conclusion I believe that every living being that live on this earth has certain common needs to survive on this earth, just like human we depend on good quality of air,water food and land to survive and fish they need good quality air water and food to survive too. So when the fish has issue we got to check the basic of their survival that is water air and food. If we can maintain those criteria in an aquarium we will not have any issue on the fish's diseases.

I'm not sure what your stated extracts from these people is meant to answer, perhaps it is Rick's question about the mode of reproduction, or at least the reference to Noga maybe? If so that is incorrect, in his second edition he makes no such comment. He may have made such an assertion in his first edition, but clearly he now feels that such assertion to be incorrect, otherwise it would remain in his second edition.

Perhaps it is the second point that Rick raised that you are trying to address, again whilst there is no doubt that left untreated and the environmental conditions not improved then death may well be the end result, but that same argument could be applied to any disease. I'm struggling to understand the point (or points) you are trying to get across here.

[mikediscus]

I'm not sure what your stated extracts from these people is meant to answer, perhaps it is Rick's question about the mode of reproduction, or at least the reference to Noga maybe? If so that is incorrect, in his second edition he makes no such comment. He may have made such an assertion in his first edition, but clearly he now feels that such assertion to be incorrect, otherwise it would remain in his second edition.

Perhaps it is the second point that Rick raised that you are trying to address, again whilst there is no doubt that left untreated and the environmental conditions not improved then death may well be the end result, but that same argument could be applied to any disease. I'm struggling to understand the point (or points) you are trying to get across here.

I was not trying to provide any answer, you jump to conclusion too fast. I was providing Rick the source where i read it from but did not aware there is a second edition and now that you brought it up I will get my hand on a copy and read it. Just like i said, I am not an expert just a hobbyist with hand on experience on the issue and sharing my views that is all.

Even with the findings of the expert are inconclusive that is why you have second edition third edition and so forth. In my opinion hand on experience is the best treatment. The point is that once it happened to the fish what do we do from there? scramble for answers, just go back to mother nature which is Water, food and air.
Just like you said in your post # 16 "Prevention is better than Cure".

[pcsb23]

Nope not jumping to any conclusions, that's why I asked what point you were trying to make. It is an open debate and I'm always interested in what others have achieved. Learning is a continual exercise and the day I stop ...

[nc0gnet0]

HITH is one of those "diseases" which I think can be attributed to many factors. I think that suggesting flagellates as the only or even primary cause is somewhat too simplistic at best. It would be nice if everything in fish health was black and white, sadly it just isn't.

I couldn't agree with this statement more! Yet, the majority of times I see a HITH thread posted, everyone jumps in and advises treatment with Metro, which is, IMO, not the best course of action, and the point I was trying to make.

Also, just to be pedantic, the flagellate in question in discus is almost certainly spironucleus vortens and not hexamita, though to all intents and purposes they are treated the same and have the same effect etc ...

I actually knew this , however, for purposes of discussion, as well as treatment (as you have mentioned), the two are virtually synonymous. Paul, I think we are pretty much on the same page in terms of HITH.

If we go back to what I had originally posted here:

IMO HITH is a catch all term applied to several different issues, all which present themselves visually in much the same way. While hexamita is often found at the infection sight, its debatable whether or not it is the root cause or just a secondary intruder. Myself I tend to believe the latter, and think more often than not, it is a bacterial infection brought on by poor water quality and/or a fish with weak immune system, resulting in an infection starting in the sensory pits and spreading outward

.

Which actually coincides with the OP's use of amoxy, an anti-biotic to treat the infection. As to whether or not amoxy has any distinct advantages over several other anti-biotics is a topic for another debate However, as we have already touched on, HITH, being that of a catch all sort of description of disease, an infection might not always be the case.......

What I really took issue with was a secondary description brought into the conversation by mikeusa888, in which the reproduction of the flagellate was described as having a larval stage. To the best of my knowledge, this is not the case at all. To add to that, I don't think HITH is the result of an internal infestation/infection of any sort that burst outwards, rather it is an external infection that tunnels inward....

[nc0gnet0]

Ok, now that I have clarified my statements earlier, I wanted to touch on this:

I believe that anything which takes away nutrients or impairs the fishes ability to properly use these nutrients can be a contributing factor to the formation of HITH. This could be an imbalance of minerals, but would more likely be a lack of trace elements that facilitate the fish using the vitamins and minerals. It could be a parasite infection such as worms or flagellates (though we tend to think of flagellates as a bacterial infection). It could be that the fish has become stressed and that has interfered with it's ability to use the nutrients and/or allowed the parasites to get the upper hand as it were. It could also be environmental or husbandry related, i.e. we are not maintain them properly.

In essence Paul, and what I believe you were trying to say, Good Food + Good Water = a healthy immune system. It stands to reason that fish that develop HITH have been subjected to compromising conditions on either one or both. But what I want to ask your opinion of, do you think there is anymore a direct link to poor diet in the case of HITH over that of other conditions such as fin rot, white pimples, white feces, etc etc?

-Rick

[nc0gnet0]

To further clarify my question let me give two human examples both using vitamin C.

a) We all (or at least most of us) know that severe lack of vitamin C can lead to the condition called scurvy. This is a direct link from a vitamin/mineral deficiency to a disease/condition.

b) It is commonly understood that taking vitamin C supplements when one has come down with a cold can often lead to a faster recovery, However, the lack of vitamin C is not seen as a direct link to the cause of the infection.

Are the studies done involving HITH and diet actually suggesting A or B?

[Martin_HONGKONG]

nc0gnet0 to answer your question, it can be A; B: A and B; Non A Non B etc. It all depends on what is the research question from the begining?

Here's an abstract on two of the roles of ascorbic acid (vitamin C) in use daily.
You can find more by search at the http://www.ncbi.nlm.nih.gov/pubmed

All publications accepted are peer reviewed by scientists who are activity working in their own field of interests

They are letters to the editor, original article and reviews.

Letters to the editor, as the name suggested, a small pieces of work to point out or usually disagree with something just published. Or it is a quick sharing in the scientific field when something unusual appear, it act as an early warning signal to fellow colleagues.
Original article can be anyone of these type of study: a Case-report study, Survey, Case-control study, Clinical trial, Cross-over clinical trial, intervention study etc..
(Each one has a different requirement for sample size, number of subjects (n), type of statically tools used etc (t-test, Chi-square etc)
Review articles, they are just like book chapters based on current and most advances developments on the field. Good resources and they are free, too

Scientists like to be questioned and re-questioned, its our job to search and search over and again, as the word research implied the job nature.
Why research?
There are differences in geographic, demographic, mutations, resistance to drugs, stains variations, advances in medicines (better to have a few more tools to flight diseases and just using the traditional one) and the list continue...

PS: Scientists have to declare conflict of interest

My declaration will be.
I have nothing to declare as I have no business associations with any of members here except, David Webber who had sent me some discus in 2004, and just asked an member here where to get for some fish food, otherwise, I do not receive fund from the Simplydiscus nor do I act as a sponsor to Simplydiscus or any member in here or their associates.




Ann Nutr Metab. 2006;50(2):85-94. Epub 2005 Dec 21.
Immune-enhancing role of vitamin C and zinc and effect on clinical conditions.
Wintergerst ES1, Maggini S, Hornig DH.
Author information


Abstract
Vitamin C concentrations in the plasma and leukocytes rapidly decline during infections and stress. Supplementation of vitamin C was found to improve components of the human immune system such as antimicrobial and natural killer cell activities, lymphocyte proliferation, chemotaxis, and delayed-type hypersensitivity. Vitamin C contributes to maintaining the redox integrity of cells and thereby protects them against reactive oxygen species generated during the respiratory burst and in the inflammatory response. Likewise, zinc undernutrition or deficiency was shown to impair cellular mediators of innate immunity such as phagocytosis, natural killer cell activity, and the generation of oxidative burst. Therefore, both nutrients play important roles in immune function and the modulation of host resistance to infectious agents, reducing the risk, severity, and duration of infectious diseases. This is of special importance in populations in which insufficient intake of these nutrients is prevalent. In the developing world, this is the case in low- and middle-income countries, but also in subpopulations in industrialized countries, e.g. in the elderly. A large number of randomized controlled intervention trials with intakes of up to 1 g of vitamin C and up to 30 mg of zinc are available. These trials document that adequate intakes of vitamin C and zinc ameliorate symptoms and shorten the duration of respiratory tract infections including the common cold. Furthermore, vitamin C and zinc reduce the incidence and improve the outcome of pneumonia, malaria, and diarrhea infections, especially in children in developing countries.
Copyright (c) 2006 S. Karger AG, Basel.


Use as anti-oxident in cooked meat, processed food, medicine and even used as a preservative.
Food Chem. 2015 Feb 1;168C:107-114. doi: 10.1016/j.foodchem.2014.07.028. Epub 2014 Jul 11.
Antioxidant properties of different products and additives in white wine.
Comuzzo P1, Battistutta F2, Vendrame M2, Páez MS2, Luisi G2, Zironi R2.
Author information
Abstract
Different winemaking products (ascorbic acid, glutathione, yeast lees and a yeast autolysate) were tested in comparison with sulphur dioxide, concerning radical scavenging activity (measured by DPPH assay), oxygen consumption capacity and ability to reduce wine colour and predisposition to browning. Trials were performed in white wines and model solution. SO2 was the most active in reducing wine colour development. Fresh lees and ascorbic acid were very effective in oxygen and free radical scavenging, but they both induced browning during wine storage, the former, by releasing phenolic compounds. Glutathione was also able to scavenge DPPH in wine, but less effective against oxygen, and it induced browning during storage. Surprisingly, the yeast derivative preparation was the treatment that behave more similarly to sulphiting; it was very active in scavenging DPPH, and, even without modifying oxygen consumption rate, it protected quite well wine colour over an 8months storage time.
Copyright © 2014 Elsevier Ltd. All rights reserved.
KEYWORDS:
Ascorbic acid; Glutathione; Oxidation; Sulphur dioxide; Wine; Yeast derivatives; Yeast lees

[nc0gnet0]

Houston........I think we have a misunderstanding.........

[pcsb23]

hehe Martin I think Rick was using the vit C as an example of his question rather than asking if that applied to vit c usage

...
In essence Paul, and what I believe you were trying to say, Good Food + Good Water = a healthy immune system. It stands to reason that fish that develop HITH have been subjected to compromising conditions on either one or both. But what I want to ask your opinion of, do you think there is anymore a direct link to poor diet in the case of HITH over that of other conditions such as fin rot, white pimples, white feces, etc etc?

-Rick

As with all of these chronic conditions I think it is difficult to be 100% sure. I believe that given good water but for the sake of argument the water lacks some mineral content then if the diet is also lacking in that mineral content I believe HITH symptoms will eventually show.

[nc0gnet0]

I believe that given good water but for the sake of argument the water lacks some mineral content then if the diet is also lacking in that mineral content I believe HITH symptoms will eventually show.

LOL,

You should be a politician! (jk)

-Rick

[DC Discus]

Thanks everyone for the discussion, I thoroughly enjoy learning from everyone's experiences! I wasn't really trying to open a can of worms (so to speak) in my questions from post #4.

I too struggle with if I'm looking at spiro or hex under the scope. I find spiro/hex in many fish species like salmon, cyprinids, and discus, oddly not in sturgeon (though maybe just haven't noticed). I've seen them around the heart and brain in addition to the gut. I've also noticed a lot of bacteria when spiro/hex is present too. I have used metro in the past with good results, but got better results from larger water changes and adding in more marine nutrients (mysis shrimp) to the diet. Regular diet was frozen blood worms and brine shrimp, flakes, and pellets.

As John said, I find spiro/hex in perfectly healthy fish that were sampled for other research purposes, though in very low densities. So I believe its present almost everywhere and the fish's environmental condition play a huge role in infection rate/density.

Martin - thanks for the abstracts I've downloaded them to browse through.
Cheers,
DC

[blueluv]

So what's the way to cure hole in the head. Which antibiotic can help cure hith? Is finn rot related to hole in the head. I ask this for a member I'm trying to help on Facebook which is dealing with finn rot. He did have a ram cichlid in with his discus that have finn rot which has hole in the head disease

[blueluv]

Bump. Anyone? If you have a moment, I'm trying to help a member on Facebook the best that I can