Powder Blue Face Wound Worsening... ID & Treatment Suggestions??

delfiend · Apr 17, 2022

Hi all, I noticed this wound on my powder blue's face about two weeks ago. I have a rabbitfish in the tank and assumed that the PB and the rabbit had gotten into it. PB still swam laps around the tank and was eating great. I chocked it up to a flesh wound that would just take time to heal and left it at that.

Last night (4/16) when I fed the tank, I noticed the PB was hanging out behind the rock work and didn't come out to catch food with the other fish. Taking this as a bad sign I decided to get a look at him & the wound as soon as he came out from behind the rocks.

Now (this morning 4/17), he has relocated to a quiet corner of the tank and I was able to get pictures of the wound again.

I'm making up water for a 50% water change currently. Tank parameters were last tested four days ago (4/13) and we as follows:
ALK 6.0
Ca 393
Mg 1246
Phos 0.5
Nitrate 24
(Ammonia & Nitrite 0)
pH 7.8
Salinity 1.026

Suggestions on what I'm dealing with? Medicated dips I could do? Anything reef safe to try in the tank?? Any and all help is really appreciated. Love this fish and want to do anything to help him pull through.

blaxsun · Apr 17, 2022

#fishmedic

Sharkbait19 · Apr 17, 2022

I’d guess that looks like a bacterial infection.
Treat in a separate hospital tank with maracyn 2 or kanaplex.

NowGlazeIT · Apr 17, 2022

Yes I would agree this looks bacterial. Gram negative bacteria Vibiro

MnFish1 · Apr 17, 2022

delfiend said:
Hi all, I noticed this wound on my powder blue's face about two weeks ago. I have a rabbitfish in the tank and assumed that the PB and the rabbit had gotten into it. PB still swam laps around the tank and was eating great. I chocked it up to a flesh wound that would just take time to heal and left it at that.

Last night (4/16) when I fed the tank, I noticed the PB was hanging out behind the rock work and didn't come out to catch food with the other fish. Taking this as a bad sign I decided to get a look at him & the wound as soon as he came out from behind the rocks.

Now (this morning 4/17), he has relocated to a quiet corner of the tank and I was able to get pictures of the wound again.

I'm making up water for a 50% water change currently. Tank parameters were last tested four days ago (4/13) and we as follows:
ALK 6.0
Ca 393
Mg 1246
Phos 0.5
Nitrate 24
(Ammonia & Nitrite 0)
pH 7.8
Salinity 1.026

Suggestions on what I'm dealing with? Medicated dips I could do? Anything reef safe to try in the tank?? Any and all help is really appreciated. Love this fish and want to do anything to help him pull through.

That is a significant wound - and needs immediate treatment - with a broad-spectrum antibiotic (as already mentioned). Additionally - to me its concerning for more than just that (a fungal infection of some sort or even a parasite) - but either way - I would immediately set up another tank - add an antibiotic. The speed at which it has progressed and the more lethargic behavior may not be a good sign - I'm sorry to say. It almost appears as if it could be a rapidly progressing vibrio infection - I would only very carefully touch the fish, equipment, etc - preferably with gloves if you have them. Hope this helps - and hope he gets better!!!

Jay Hemdal · Apr 17, 2022

Not to add insult to injury, but in the third picture down, those spots further back on the body sure look like ich trophonts.

I agree, this looks like a bacterial lesion, Aeromonas, Vibrio or Pseudomonas are all commonly seen.
Jay

delfiend · Apr 17, 2022

UPDATE:

Quarantine tank (brute) has been filled, new saltwater mixed to 1.022, temps around 75°F and rising. Dosed with Maracyn Oxy bc it's what I get get ahold of short notice, have some Maracyn 2 shipping.

However, I caught my PB and snapped a quick pic while I had him out of water; looks pretty horrible. I'm not too familiar with fish & their various ailments, but am I mistaken in thinking this looks like necrosis? I'm seeing an open wound and a lot of dissolved flesh around the area

It looks pretty bleak, but I'll keep him comfortable in his brute and follow the medication(s) instructions until he either gets better or passes on. Thanks everyone for your quick responses, and I'll post an update again when there's one to give!

Malcontent · Apr 17, 2022

I'd recommend a fish vet for more rapid treatment, typically injectable cephalosporins.

Otherwise, ciprofloxacin is the best OTC option for freshwater fish and probably what I'd try in saltwater as well. I've ordered from them on a Friday and received the meds on Monday with their free shipping option (USPS priority).

Due to the severity of the infection I'd really recommend a vet though. I do get a few hits for "fish vet Columbus" (I'm assuming Ohio).

KanaPlex dosed per the instructions is < 2 mg/L (Noga's book recommends 50-100 mg/L). I often read about people using KanaPlex with no success and that may be the reason.

MnFish1 · Apr 17, 2022

PS. If indeed it is vibrio, pseudomonas or aeromonas - the maracyn OXY is not likely to help. You need a medication with broad gram negative coverage. Kanaplex would be good. Cipro would be ok. It always seems these things happen on a weekend or a holiday - when the options are limited. You may be able to call a veterinary emergency clinic - and get Cipro - temporarily until you can get kanamycin. They should be open today - and will likely Make an effort to help. Whether they have a fish vet on staff or not. Hope you have some success!!

Malcontent · Apr 17, 2022

Find a Fish Vet – AAFV FishVets.org

fishvets.org

Not an exhaustive list so some Googling may turn up more options. Sometimes you have to go to the website of every exotics vet within range and see if they treat fish.

NowGlazeIT · Apr 17, 2022

Malcontent said:
I'd recommend a fish vet for more rapid treatment, typically injectable cephalosporins.

Otherwise, ciprofloxacin is the best OTC option for freshwater fish and probably what I'd try in saltwater as well. I've ordered from them on a Friday and received the meds on Monday with their free shipping option (USPS priority).

Due to the severity of the infection I'd really recommend a vet though. I do get a few hits for "fish vet Columbus" (I'm assuming Ohio).

KanaPlex dosed per the instructions is < 2 mg/L (Noga's book recommends 50-100 mg/L). I often read about people using KanaPlex with no success and that may be the reason.

Cephalosporin for the win
Wish my vet got down like this. Probably a pretty penny tho yea?

Malcontent · Apr 17, 2022

NowGlazeIT said:
Cephalosporin for the win
Wish my vet got down like this. Probably a pretty penny tho yea?

I took one of my clown loaches to UC Davis in 2012 back when I lived in CA. I don't remember the cost being too bad. He was tube fed and given ceftiofur. That fish will be at least 20 years old next year.

KanaPlex needs 12 g per 20 gal to attain 50 mg/L and it's $14 per 10 g so three treatments (36 g) is $50 already... And being an old antibiotic there could be 50% resistance.

MnFish1 · Apr 17, 2022

NowGlazeIT said:
Cephalosporin for the win
Wish my vet got down like this. Probably a pretty penny tho yea?

You need to be extremely careful - there are first, second and third generation cephalsporins. 1 and 2 generation will have no or little effect. If you're going to treat with a cephalosporin - you will need a third generation and you may need to add something like tetracycline or copra Any veterinary emergency clinic can give you some tablets - just based on the picture I would imagine. Many pseudomonas strains also require 2 drugs Aeromonas - is a totally different issue - which may be sensitive to many antibiotics - including a second generation cepahlosporin.

Bottom Line - show the picture to a veterinarian OR find a way to get an MD friend to give you a prescription you can pick up on Easter Sunday. I doubt many fish veterinarians are sitting around waiting for a call.. IMHO - your best bet is talking to a regular veterinary emergency clinic - that is open - and getting medication that will treat pseudomonas, vibrio and aeromonas. Not trying to be disagreeable with anyone - but - IMHO - this is not a problem that will wait overnight - of course - stranger things have happened. IMHO - again - a third generation cephalosporin with or without Cipro - is your best bet (as a microbiologist - though not a 'fish one')

"Susceptibility patterns to 16 different antibiotics were investigated against pathogenic Vibrio spp. and Aeromonas spp. isolated from shrimp culture hatcheries and ponds in India. Thirteen species of Vibrio (N = 90) and two species of Aeromonas (N = 7) isolates were tested by agar disk diffusion. The results show that 100% of the isolates were resistant to ampicillin, and that 43.2% and 47.4% were sensitive to chlortetracycline and erythromycin, respectively. Susceptibility patterns of another 160 isolates belonging to the genera Vibrio and Aeromonasobtained from the water samples of shrimp hatcheries and ponds were tested against six commonly used antibiotics. Results indicate that isolates from the hatcheries were more resistant to antimicrobials than isolates from the ponds. The minimum inhibitory concentrations of five antibiotics against the different Vibrio spp. and Aeromonas spp. were determined. Ciprofloxacin was found to be the most effective in controlling the isolates from hatcheries and ponds compared with the other antibiotics used in the study. Our results reveal that antibiotic-resistant bacteria are widespread in the shrimp culture hatcheries and ponds in India. Potential risk to human health was not addressed in this study and remains to be elucidated."

NowGlazeIT · Apr 17, 2022

MnFish1 said:
You need to be extremely careful - there are first, second and third generation cephalsporins. 1 and 2 generation will have no or little effect. If you're going to treat with a cephalosporin - you will need a third generation and you may need to add something like tetracycline or copra Any veterinary emergency clinic can give you some tablets - just based on the picture I would imagine. Many pseudomonas strains also require 2 drugs Aeromonas - is a totally different issue - which may be sensitive to many antibiotics - including a second generation cepahlosporin.

Bottom Line - show the picture to a veterinarian OR find a way to get an MD friend to give you a prescription you can pick up on Easter Sunday. I doubt many fish veterinarians are sitting around waiting for a call.. IMHO - your best bet is talking to a regular veterinary emergency clinic - that is open - and getting medication that will treat pseudomonas, vibrio and aeromonas. Not trying to be disagreeable with anyone - but - IMHO - this is not a problem that will wait overnight - of course - stranger things have happened. IMHO - again - a third generation cephalosporin with or without Cipro - is your best bet (as a microbiologist - though not a 'fish one')

"Susceptibility patterns to 16 different antibiotics were investigated against pathogenic Vibrio spp. and Aeromonas spp. isolated from shrimp culture hatcheries and ponds in India. Thirteen species of Vibrio (N = 90) and two species of Aeromonas (N = 7) isolates were tested by agar disk diffusion. The results show that 100% of the isolates were resistant to ampicillin, and that 43.2% and 47.4% were sensitive to chlortetracycline and erythromycin, respectively. Susceptibility patterns of another 160 isolates belonging to the genera Vibrio and Aeromonasobtained from the water samples of shrimp hatcheries and ponds were tested against six commonly used antibiotics. Results indicate that isolates from the hatcheries were more resistant to antimicrobials than isolates from the ponds. The minimum inhibitory concentrations of five antibiotics against the different Vibrio spp. and Aeromonas spp. were determined. Ciprofloxacin was found to be the most effective in controlling the isolates from hatcheries and ponds compared with the other antibiotics used in the study. Our results reveal that antibiotic-resistant bacteria are widespread in the shrimp culture hatcheries and ponds in India. Potential risk to human health was not addressed in this study and remains to be elucidated."

I’m confused about the 3 generations of antibiotic. What are they? Different concentrations of the same drug?

MnFish1 · Apr 17, 2022

NowGlazeIT said:
I’m confused about the 3 generations of antibiotic. What are they? Different concentrations of the same drug?

No - First generation cephalosporins (like Keflex) -were designed as a substitute for people allergic to penicillin. Second Generation - was a newer class produced when many bacteria became resistant. Third generation cephalosporins were designed to be very broad spectrum - including both gram positive and gram negative organisms. There are other generations as well:

Cephalosporin - Wikipedia

en.wikipedia.org

NowGlazeIT · Apr 17, 2022

MnFish1 said:
No - First generation cephalosporins (like Keflex) -were designed as a substitute for people allergic to penicillin. Second Generation - was a newer class produced when many bacteria became resistant. Third generation cephalosporins were designed to be very broad spectrum - including both gram positive and gram negative organisms. There are other generations as well:

Cephalosporin - Wikipedia

en.wikipedia.org

Great tip thank you for the link

NowGlazeIT · Apr 17, 2022

MnFish1 said:
No - First generation cephalosporins (like Keflex) -were designed as a substitute for people allergic to penicillin. Second Generation - was a newer class produced when many bacteria became resistant. Third generation cephalosporins were designed to be very broad spectrum - including both gram positive and gram negative organisms. There are other generations as well:

Cephalosporin - Wikipedia

en.wikipedia.org

There are so many variations of this antibiotic! I can’t find a third generation use in fish only cats and dogs hah