Internal Issues

[Greenjeans]

I would like to treat with metroplex and prazipro using focus to bind it to frozen mysis. How much prazi should I use (per the recipe in the OP)?

Or should I pick up some General Cure?

 

[FirstContact]

I thought Hikari Prazipro went in the water per bottles directions. Repay at day 5.

Seachem Metro & Focus bind to food for internal parasites.

Humblefish is the expert.

 

[Big G]

Food + General Cure + Focus + a bit of RO mixed to your desired consistency works pretty good for treating internal parasites. Can add a pinch of plain USP epsom salts to the mix to help "move along" the dead worms. Feed once a day for 10-14 days.

 

[Super Fly]

all fish r eating medicated food with garlic added for flavor except for Lyretail Anthia. It's not even eating thawed frozen (food+GC+Focus+garlic) that it normally gobbles up ... any suggestions @Humblefish @Big G ?

 

[Big G]

all fish r eating medicated food with garlic added for flavor except for Lyretail Anthia. It's not even eating thawed frozen (food+GC+Focus+garlic) that it normally gobbles up ... any suggestions @Humblefish @Big G ?

The Metro can often be off putting to fish's appetite. Might want to try something else that is dosed directly into the water, and then just use regular foods. Perhaps something like this:

 

[Super Fly]

The Metro can often be off putting to fish's appetite. Might want to try something else that is dosed directly into the water, and then just use regular foods. Perhaps something like this:

Is this safe to use in reef tank w anemone?

 

[Big G]

No. It's a blend of Kanaplex + Furan2. Not reef safe; is QT safe.

 

[Super Fly]

No. It's a blend of Kanaplex + Furan2. Not reef safe; is QT safe.

ok, thx. After ur note, I looked under the stand and found calan-eeze and decided to give that a try. Wouldn't you know it, anthia's gobbling it up even though its medicated! now I have to restart the14 day treatment all over again... hopefully the extra 2 weeks of treatment will be ok for other fish.

 

[Super Fly]

Been treating tank for 3 weeks now but yesterday still saw white stringy poop on one of the clowns, meanwhile the Anthia has normal poop... thought 2 weeks of feeding medicated food would take care of internal parasite? Gonna treat for another week and see, meanwhile any advice would be appreciated.

 

[Phishguy3.0]

Internal Issues

For simplicity’s sake, there are 6 basic problems a marine fish may experience on the inside:

1. Intestinal worms
Symptoms: White stringy feces, pinched stomach, loss of color, fish eats voraciously but still seems to be losing weight.
Treatment of choice: Praziquantel
Alternative treatments: Fenbendazole, Levamisole, Piperazine

2. Internal parasites/flagellates
Symptoms: White stringy feces, pinched stomach, loss of color, fish eats voraciously but still seems to be losing weight. Flagellates are more virulent than worms, and thus can kill faster.
Treatment of choice: Metronidazole
Alternative treatments: Albendazole, Flubendazole and Mebendazole all show promise.

3. Internal infections (bacteria)
Symptoms: Bloating, and lumps or swollen areas on the body. Also, poor water quality can cause/aggravate an internal infection.
Treatment of choice: Metronidazole combined with Neomycin Sulfate in a medicated fish food slurry can be a very good full spectrum internal/gut infection treatment, treating both aerobic and anaerobic bacteria.
Alternative treatment: Seachem Focus claims to be an antibacterial polymer for internal infections of fish. The active ingredient found therein is nitrofurantoin.

4. Swim bladder disorder
Symptoms: Fish swims vertically with its tail up. Basically, the back half of the fish will seem more buoyant than the front half, and the fish will swim in a way to compensate for that. The fish may also stay near the surface of the water (or even float), unable to swim downwards. A protrusion (i.e. gas bubble) may be visible near the swim bladder area. In most cases, swim bladder disorders are caused by improper decompression of deep water species of fish.
Treatment: If a gas bubble is present, you can lance the air out using a 30 gauge insulin syringe. For swim bladder infections, the following are possible treatment options:
(1) Dose magnesium sulfate (Epsom Salt) at 1 tablespoon per 5 gallons.
(2) Give the affected fish a 30 minute Methylene Blue bath.
(3) Dose Metronidazole in conjunction with Neomycin. (You can food soak this combination as well.)

5. Spinal injury
Symptoms: Fish swims vertically with its tail down. Sometimes the fish just lays on the bottom of the tank; sometimes swims in a swirling motion. Most believe spinal injuries are caused when the fish jumps and hits a hard object (or swims/rams into one.) However, there is some evidence that internal flagellates and/or harmful bacteria which has migrated to the spinal canal may be contributing factors to spinal injuries. Wrasses seem most prone to spinal injuries, especially fairy & flasher wrasses.
Treatment: The injury can heal if the damage is not too severe. Sadly, this is most often not the case. Dosing Metronidazole (for internal flagellates) + Erythromycin or Enrofloxacin (for bacteria) may help. If the fish is still eating, food soak metronidazole + neomycin as well.

6. Fish constipation
Symptoms: Bloated stomach, obvious anal obstruction, rectal prolapse, erratic swimming behavior. The fish will sometimes stay near the surface of the water, swimming in circles. Constipation is sometimes mistaken for a gas bubble in a fish’s swim bladder (or vice versa.)
Treatment options:
(1) Feed peeled boiled green peas (high in fiber)
(2) Dose Epsom salt @ 1 tablespoon per 5 gallons (laxative)
(3) Dose Kanamycin (Seachem Kanaplex) in a Quarantine Tank (diarrhea is a side effect of kanamycin)

Internal parasites vs. intestinal worms – Since these can be difficult to distinguish due to near identical symptoms, it is best to always treat with praziquantel + metronidazole so both pathogens are covered. You can combine different medications (e.g. Prazipro + Seachem Metroplex), or API General Cure contains both.

Does the color of the poop matter? – Yes! It has to be white. Brown stringy poop, for example, can just mean intestinal irritation which requires no treatment.

Food soaking vs. dosing the water – Sometimes dosing the water with the above medication(s) can help clear an internal pathogen. After all, fish do drink the water, and their skin will absorb medications. However, I feel soaking fish food with medication(s) is the best way to treat internal problems for obvious reasons. Food soaking delivers meds directly into the gut where most internal pathogens live. In order to food soak, you should also use a binder (e.g. Seachem Focus, unflavored gelatin, agar) to prevent the medication from just leaching out into the water. Binding also makes the treatment reef safe.

My recipe for food soaking metro (and prazi) can be found below:

Using a shot glass:
1 scoop (~ 1/8 teaspoon) of medication (Metroplex or General Cure)
1 scoop Seachem Focus (this makes it reef safe)
1 Tbsp food (preferably pellets or frozen food)
A pinch of Epsom salt to help expel dead worms/parasites
A few drops of saltwater or fish vitamins
Stir until a medicated food slurry has been achieved.
Feed after soaking for 30 mins.
Refrigerate or freeze any leftovers for future use.
You can feed this mix 1-2 times per day. Not recommend to exceed 2 feedings per day with medicated food.

Final Thoughts – Due to the resilience of these critters, it is recommended to treat (or food soak) for a minimum of 10 days. However, it is not uncommon for symptoms to persist for up to 3 weeks.

And just like with any other disease, you will sooner or later run up against a strain which seems resistant to the preferred treatment. In which case, you should seek out an alternative medication. (e.g. Using fenbendazole, levamisole or piperazine in lieu of praziquantel to treat stubborn intestinal worms.)

Thanks for positing this information. It’s really helpful.

 

[Hypnotoad]

I’ve been struggling with the white stringy poo and it’s obviously contagious.

I fed a Metro-focus slurry for almost 4 weeks. Fish looked good, then I stopped for a week and the stringy poop is back.

just started with medicated food again, should I try Prazi/general cure this time?

Are these parasites just really stubborn sometimes?

Also, are there any I’ll effects associated with longer courses of treatment than those outlined in the original post?

 

[Super Fly]

I’ve been struggling with the white stringy poo and it’s obviously contagious.

I fed a Metro-focus slurry for almost 4 weeks. Fish looked good, then I stopped for a week and the stringy poop is back.

just started with medicated food again, should I try Prazi/general cure this time?

Are these parasites just really stubborn sometimes?

Also, are there any I’ll effects associated with longer courses of treatment than those outlined in the original post?

yes, I used both meds (Focus & GC) and after treatment parasite gone. Apparently not all parasites are addressed when using only focus so they recommend treating with both meds to cover all bases. I would restart treatment using Focus & GC. GL

 

[Billythekidd7]

I have a small clownfish he constantly poop rly long white stringy poop that is stuck to him for awhile I don’t understand why I feed frozen reef frenzy and I dosed api general cure directly in tank and it still has it... He is still eatting but when I tried to dose the food he wanted no part any idea what I can do

 

[Super Fly]

I have a small clownfish he constantly poop rly long white stringy poop that is stuck to him for awhile I don’t understand why I feed frozen reef frenzy and I dosed api general cure directly in tank and it still has it... He is still eatting but when I tried to dose the food he wanted no part any idea what I can do

instead of treating water, GC should be soaked into food so med can be directly ingested into stomach to target the parasites. Use Focus to bind the GC med into food, I mixed Focus n GC into pellets n Reef Frenzy w a little tank water, let it sit 30 mins prior to feeding. Feed max 2x/day n treat at least 2 weeks. I treated my tank 4 weeks (bc Anthia wasnt eating first batch, had to use Calan Eeze for him) n no more white stringy poo. GL

 

[Billythekidd7]

instead of treating water, GC should be soaked into food so med can be directly ingested into stomach to target the parasites. Use Focus to bind the GC med into food, I mixed Focus n GC into pellets n Reef Frenzy w a little tank water, let it sit 30 mins prior to feeding. Feed max 2x/day n treat at least 2 weeks. I treated my tank 4 weeks (bc Anthia wasnt eating first batch, had to use Calan Eeze for him) n no more white stringy poo. GL

Do you know how much water I should mix in with reef frenzy and general cure and focus and is it ok if the food it watery? Also how long can I refrigerate it

 

[Billythekidd7]

Do you know how much water I should mix in with reef frenzy and general cure and focus and is it ok if the food it watery? Also how long can I refrigerate it

also should I use one packet

 

[Super Fly]

Do you know how much water I should mix in with reef frenzy and general cure and focus and is it ok if the food it watery? Also how long can I refrigerate it

enough water to make a slurry of the food n meds, not too watery. Can keep refrigerated up to a week. I believe there’s recipe instruction somewhere in one of the early posts here, I used 1/2 teaspn of each med w one tblspn worth of food

 

[Billythekidd7]

enough water to make a slurry of the food n meds, not too watery. Can keep refrigerated up to a week. I believe there’s recipe instruction somewhere in one of the early posts here, I used 1/2 teaspn of each med w one tblspn worth of food

question lol
Third day of feeding meds noticed poop went from white and stringy to clear and stringy is that a better sign

 

[Super Fly]

question lol
Third day of feeding meds noticed poop went from white and stringy to clear and stringy is that a better sign

I guess?... as long as they’re eating the medicated food for 2 weeks, should be good to go.

 

[Humblefish]

Little update:

Fish with internal pathogens (white stringy poo) are usually afflicted by either internal flagellates (parasitic diplomonads) or intestinal worms. Most intestinal worms are going to be trematodes, cestodes or nematodes.

The treatment of choice for internal flagellates is metronidazole, although food soaking chloroquine or flubendazole are viable alternative. Since those two drugs are often still available in countries (like the UK) where metronidazole requires a Rx.

For intestinal worms, this is what treats what:

1. Praziquantel: Treats trematodes & cestodes only.
2. Piperazine: Treats nematodes only.
3. Fenbendazole: Treats trematodes, cestodes and nematodes.

So clearly, food soaking Fenbendazole + Metronidazole in a QT environment will give you the widest treatment coverage for internal issues. DO NOT use Fenbendazole in a reef tank because it will kill corals (no matter how much Focus you use.) Food soaking General Cure (which contains prazi + metro) is still your best option in a reef tank because both medications are mostly reef safe.

Alternatively, you could food soak General Cure + Piperazine (on alternating days) in QT to provide the same treatment coverage as food soaking Fenbendazole + Metronidazole. However, I have no idea whether or not Piperazine is reef safe.

For those who are completely opposed to using medications, I am seeing good results just by food soaking magnesium sulfate (Epsom salt) to "flush" the pathogens out of the intestines. However, this won't help with diplomonads (e.g. Hexamita) that tend to migrate to other parts of the body (sensory pores, spinal column, etc.)