The Bacterial Infection Predicament

Please do not view the information below as a shortcut to quarantine. Use it only in an EMERGENCY SITUATION when treating a fish with...
  1. Humblefish

    Humblefish Dr. Fish R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    The Bacterial Infection Predicament


    Please do not view the information below as a shortcut to quarantine. Use it only in an EMERGENCY SITUATION when treating a fish with parasites/worms PLUS a serious bacterial infection.

    So, your fish has a nasty bacterial infection. :eek: You've treated with antibiotics for 10 days and it's still not looking any better. What gives?!

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    Photo by: ngoodermuth

    Why fish get bacterial infections - We all know the water in our aquarium is full of bacteria. Most of it is good (like nitrifying bacteria), but some can be bad and harmful to marine animals. The bad kind is usually kept at bay by a healthy fish's natural immune system. Or if the fish becomes "sick" and displays symptoms of a bacterial infection, many times the immune system is still able to fight it off without the aid of antibiotic medication. So if you stop and think about it, these bacterial infections in fish are akin to our own never-ending battle with germs, viruses, and of course, infections. :rolleyes:

    Many factors make a fish more susceptible to infection. First, a cut or open wound is usually required for infection to set in. Even tiny exit wounds left by feeding parasites or worms can get infected. Poor water quality can be a contributing factor as bacteria seem to prefer dirty wounds. ;Sour Also, anything that lowers the fish's overall immune system makes infection more likely. Stress (e.g. fish fighting), malnourishment, or if the fish is battling an ongoing parasitic (e.g. ich, velvet) or worm (e.g. flukes, turbellarians) infestation makes a "secondary" bacterial infection probable. For example, back when I practiced "ich management" it seemed periodically I would have a fish develop “popeye” or some suspicious red mark. Now that I quarantine (QT) and prophylactically treat all my fish, I almost never see anything like that once the fish enters my display tank (DT). Disease-free fish are healthier fish and more capable of overcoming potential infections. In any case, it's these "secondary" infections which cause the predicament which is the subject of this article.

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    Photo by: Chicago

    The Predicament - So, your fish has ich or velvet PLUS a bacterial infection. :eek: Friend, you've got a serious problem on your hands. :( In most cases, treating for the parasite takes precedence over the bacterial infection - this is especially true when dealing with Marine Velvet Disease. However, the two chemicals most commonly used to treat ich & velvet - copper and Chloroquine phosphate - are both immunosuppressants. So while these are working to eradicate the parasites, they are also suppressing the strength of the fish’s immune system, thus reducing it's capacity to fight off whatever infection is afflicting your fish. Remember, antibiotics, in and of themselves, do not cure a fish. Antibiotics merely control the population growth of bacteria in a fish long enough for its immune system to eliminate them. In all cases, proper nutrition will play a critical role in helping your fish overcome infection. It is very important to feed vitamin enriched foods and ones which contain probiotics when your fish are sick. Proper nutrition + medication is a 1-2 punch to help combat illness and disease.

    What to do for Ich + Bacterial Infection - Tank transfer method is your best option in this situation because no chemicals are being used to eliminate the parasites. So, you can freely dose antibiotics in conjunction. You'll have to time your dosages just right so as to not waste the medication(s); but remember most antibiotics dissipate out of the water after 24 hours anyway. ;)

    Hyposalinity would be my second choice, only because hypo resistant strains of ich have been proven to exist (study done by Yambot in 2003.) However, being no chemicals are used you would dose antibiotics for a minimum of 10 days in conjunction with hypo.

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    Photo by: Jordan Berry

    What to do for Velvet + Bacterial Infection - This is the worst predicament to be in, and unfortunately often the most common. :( Due to the severity of velvet, the use of copper or Chloroquine phosphate must commence ASAP. Antibiotics can still be dosed in conjunction, but appetite suppression will likely increase and additional gas exchange must be provided to compensate for the added oxygen depletion. It is also possible that you will encounter a bacterial bloom from combining too many meds. To counteract this, use an air stone or point a powerhead towards the surface of the water in order to supply more available oxygen to your QT. Other tips for accomplishing this are discussed here: https://www.reef2reef.com/threads/oxygen-while-using-meds.258949/

    Unfortunately, oftentimes combining antibiotics + copper/CP will only keep an infection at bay, or it might even get worse. Sometimes using an herbal remedy (such as Melafix) is a wiser and more cost effective option at this point, to just boost the immune system until proper antibiotics can be administered without copper/CP in the water (described below). Another thing you can do to help is give the fish periodic baths using an antiseptic (acriflavine is a good choice). This should slow down the progression of the infection. However, it is imperative to get the fish out of copper/CP ASAP so that antibiotics can be dosed without the immunosuppressant being present. The protocol below explains how to best accomplish this, but also allows NO MARGIN FOR ERROR. Everything must be done exactly as stated:
    1. Give the fish a 5 minute freshwater dip, followed by a 90 minute acriflavine bath in saltwater.
    2. Place the fish in QT, and raise copper or Chloroquine to therapeutic levels. With Chloroquine this can be done immediately, but for copper it is best to take 48 hours (for velvet) to reach therapeutic.
    3. You'll also want to start dosing an antibiotic or an herbal remedy (such as Melafix) to contain the infection.
    4. Once copper/CP has reached full therapeutic (very important), begin a 5 day countdown. On Day 5 (although waiting a little longer is always better if the infection doesn't look too bad), transfer the fish to a non-medicated holding tank at least 10 feet away from the QT (more info regarding aerosol transmission). DO NOT reuse ANYTHING from the QT for the holding tank; only transfer the fish. The fish should be velvet free following the transfer, because within 4 days any remaining trophonts will drop off the fish. The presence of copper/CP will shield your fish from reinfection and any unhatched tomonts will be left behind in the original treatment tank. ;)
    5. Now that the immunosuppressant is out of the way, it's time to get serious about knocking out this bacterial infection. Antibiotics are notoriously slow acting in fish, so continuous treatment for 10-14 days is usually required. Below are two wide spectrum antibiotic regimens I use:
    • Combining Kanaplex + Furan-2 + Metroplex
    OR
    Only treating with copper or CP for 5 days is cutting it very close, and only works if you can transfer the fish to another tank at least 10 feet away. Therefore, it would be wise to observe for an extended period of time (4-6 weeks) to ensure velvet is really gone. Also, both copper/CP treatment (QT#1) and followup antibiotic treatment (QT#2) are best done in a rockless/bare bottom tank - as sterile an environment as possible.

    ** This treatment protocol also works for ich + bacterial infection; however for ich, the fish must be in therapeutic strength copper or CP for at least 8 days before transferring. However, I prefer a 10 day transfer just to allow a little more wiggle room. :)

    What to do for Brook & Uronema + Bacterial Infection -
    1. Give the fish a 5 minute freshwater dip (optional).
    2. Followed by either a 45 minute formalin bath or 90 minute acriflavine bath in saltwater (highly recommended).
    3. Place the fish in QT, and treat with this combination of meds for 10-14 days: Kanaplex + Furan-2 + Metroplex. Since uronema can also infect a fish internally, fish food should be laced with metronidazole for 10-14 days as well. Use Seachem Focus to bind the medication to the food, to prevent it from just leaching out: https://www.reef2reef.com/threads/metronidazole.298762/#post-3655831
    What to do for Worms (flukes, turbellarians) + Bacterial Infection - You can dose Prazipro in conjunction with most antibiotics (but only in a QT). However, Prazipro will sometimes interact negatively with other medications due to the Oxybispropanol it contains. The main thing you'll want to watch out for is a bacterial bloom (very cloudy water). A severe bacterial bloom can starve all oxygen out of the water and cause your fish to die due to asphyxiation. :eek: Adding an air stone or pointing a powerhead towards the surface will sometimes counteract this by providing more available oxygen. However, it is always prudent to keep freshly mixed saltwater on hand to perform a large water change if needed. DO NOT add more medication(s) to the water until after it has completely cleared.

    [​IMG]
    Photo by: JP 75

    Final thoughts/disclaimer - Some of the methods described above offer less than ideal solutions. In particular, only treating with copper/CP for velvet (for 5 days) or ich (for 8 days) is probably cutting it too close for comfort. (As stated above, a few extra days in copper/CP would be better.) The science behind it is sound, as velvet trophonts can only remain on a fish a maximum of 4 days, and 7 days for ich. And so long as copper or CP has been maintained at therapeutic levels the entire time, any free swimmers would not be viable by the time they reached a fish. However, this method does not take human error into consideration (e.g. you forget to test your copper level one day), and attention to detail is required to ensure precision. For these reasons, I struggled with whether or not I should be recommending what I have outlined above, but in the end, I could not in good conscience withhold scientifically accurate information which could potentially save a fish's life. After seeing how many fish were dying in copper due to secondary bacterial infections, and knowing that many gram-negative infections can kill within just a matter of days... I felt it was necessary to recommend a more aggressive treatment strategy whenever a secondary infection is also in play. To be clear, I consider the above only a stopgap measure until better methods can be developed. Indeed, finding more effective treatments for bacterial infections is high on my priority list. I feel we (as a community) are getting better when it comes to treating parasites and worms but still lacking when faced with a gram-negative bacterial infection afflicting a fish. This is unacceptable :mad:; there HAS TO BE a better way. ;Bookworm ;Doctor
     
    Last edited by a moderator: Jun 14, 2017
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  2. Maritimer

    Maritimer Moderator Staff Member Team R2R R2R Supporter R2R Excellence Award CTARS Member Partner Member 2019 Reef Tank 365 Build Thread Contributor

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    So very much _this_.

    Thank you, Humblefish.

    ~Bruce
     
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  3. Fishfinder

    Fishfinder Valuable Member R2R Supporter

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    Great write up!! Thank you. Why is a month in copper/CP recommended if it only takes 8-10 days?
     
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  4. jinbing0905

    jinbing0905 Active Member

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    Thx
     
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  5. Maritimer

    Maritimer Moderator Staff Member Team R2R R2R Supporter R2R Excellence Award CTARS Member Partner Member 2019 Reef Tank 365 Build Thread Contributor

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    It takes 8-10 days for the actively feeding parasites to drop from the fish - but copper and CP don't work well on encysted ones. You can only remove the fish from copper / CP that early if you have a second, completely clean tank, at least 10 feet from the first one. In the original tank, there are encysted parasites waiting to pounce, but by 30 days _usually_ the meds have penetrated into the cysts, and it should be safe to discontinue using them in the original tank.

    ~Bruce
     
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  6. 4FordFamily

    4FordFamily Tang, Angel, & Wrasse Addict Staff Member Team R2R R2R Supporter R2R Excellence Award Partner Member 2019 Article Contributor Hospitality Award Expert Contributor Build Thread Contributor

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    Because 10 days only works with no human error (flawless implementation which I've never been able to pull off, honestly) and because the fish are usually in the same quarantine for the duration of the treatment. If you cannot transfe the fish, it'll take 30 days to be sure. I've actually even messed this up a multitude of ways -- it takes daily testing and 100% focus on not contaminating. Even your hands going from tank to tank (even after washing them) can cause this all to fail.
     
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  7. 4FordFamily

    4FordFamily Tang, Angel, & Wrasse Addict Staff Member Team R2R R2R Supporter R2R Excellence Award Partner Member 2019 Article Contributor Hospitality Award Expert Contributor Build Thread Contributor

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    By the way - GREAT thread, Humble!
     
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  8. Fishfinder

    Fishfinder Valuable Member R2R Supporter

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    Ok I understand now.:cool:
     
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  9. melypr1985

    melypr1985 totally addicted R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    This is awesome @Humblefish! I'd like to turn it into an article with your permission
     
  10. ngoodermuth

    ngoodermuth Valuable Member R2R Supporter R2R Excellence Award Reef Squad Reef Tank 365 Hospitality Award Build Thread Contributor

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    This is very informative, and super helpful. I've been in the exact same predicament with my QT, mostly because I am limited to one large QT.

    Because I had to run the full 30 days of copper, I struggled to keep the infection at bay. With the copper now gone, I'm hoping the fish can fight it off easier.
     
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  11. Humblefish

    Humblefish Dr. Fish R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    You have my perpetual permission to use anything I write any way you see fit. ;)
     
  12. melypr1985

    melypr1985 totally addicted R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    awesome :) Your the best Mister!
     
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  13. Humblefish

    Humblefish Dr. Fish R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    Added this at the top...

    Edit: Please do not view the information below as a shortcut to quarantine. Use it only in an EMERGENCY SITUATION when treating a fish with parasites/worms PLUS a serious bacterial infection.
     
  14. 4FordFamily

    4FordFamily Tang, Angel, & Wrasse Addict Staff Member Team R2R R2R Supporter R2R Excellence Award Partner Member 2019 Article Contributor Hospitality Award Expert Contributor Build Thread Contributor

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    I was going to suggest article but i am late to the party :D
     
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  15. revhtree

    revhtree Owner Administrator Staff Member Team R2R R2R Supporter R2R Excellence Award Photo of the Month Award Partner Member 2019 Cyber Monday Sponsor R2R Secret Santa Article Contributor Build Thread Contributor

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    Another great topic written by our very own! Thank you for your labor of love!
     
  16. kandymann

    kandymann Active Member

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    @Humblefish thanks for the article. I wish I knew this information prior to now but knowing this now will make QT a lot more easier for me in the future.
    I just went through a velvet outbreak and now finally have velvet 100% eradicated. I lost about 20% of my fish and I have a lot of fish but I acted in time. For me it is possible to set up several QTs and knowing that it is possible to successfully eradicate ich/velvet within 10 days in QT is awesome. I can maintain this type of therapy for that long no problem.
     
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  17. klp

    klp Active Member

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    I will only echo the obvious. Fantastic article, particularly with all the links that I have not have time to explore yet but will. You do a wonderful work for us all here.

    Paul B suggests feeding live food such as black, white worms to build their immune system. Have you tried that instead of medications for bacterial infections? If I read him right it may be a cure for most everything but I would like to see his methods employed by people like yourself who can monitor and intercede if necessary with medications, let it go if not. With his tank as a documented example I would like to see if it could be duplicated in say a QT tank.

    Thanks again for the great service you and others do for us all! Best website I have ever seen for anything saltwater!
     
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  18. Brew12

    Brew12 Electrical Gru Staff Member Team R2R R2R Supporter Reef Squad Leader R2R Excellence Award Partner Member 2019 Reef Tank 365 Article Contributor Build Thread Contributor North Alabama Reef Club

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    What Paul B does will definitely help when it comes to bacteria infections. He makes no claims that his fish are cured of parasites like Ich and Velvet. Instead, he uses low stress and great nutrition to build up his fish's immunity to the point where these parasites are still present but aren't harming his fish. IMO, this is an amazing way to run a tank but isn't going to be easy for many reefers. First, his tank is amazingly stable. He just doesn't mess with it. He also runs his system "dirty". If you don't like things floating around in your tank, or want to keep your nitrates down, his system is not for you. This stable environment is great for reducing fish stress. Keeping stress down is critical in a system like his. One stressor event can cause the fish to lose their immunity very quickly (such as a heater failure or stuck on ATO). This gives the parasites a window to do damage to the fish and reproduce rapidly. This is why many people don't realize they have ich or velvet in their systems, some times for years. They may not add anything to their tank for 6 to 8 months, have a 2 hour power outage, and next thing they know their fish are dying.
     
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  19. Humblefish

    Humblefish Dr. Fish R2R Supporter R2R Excellence Award Article Contributor Expert Contributor Moderator Emeritus

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    Many years ago I tried that. Just passive observation in QT, good nutrition, and I never treated with any chemicals unless I saw obvious symptoms of disease. My main DT was a 400 gallon with batfish, various angels & butterflies, and a show-sized Moorish Idol. All the MI really ate in the 5 years I had him was live blackworms, so that was a staple in both QT & DT. Everything was going great, until about 10 years in a Hurricane came which caused an extended power loss. (I didn't have a generator back then.) I was able to keep temp under control and the tank oxygenated using several battery powered air pumps, but it was at this time that I discovered my DT had latent ich. :( Secondary infections then started to break out, and I lost almost all of my fish. It was like this chain of events rapidly unfolding in front of my very eyes, but I was powerless to stop it. It was an emotionally devastating experience for me, as some of these fish were 10+ years old. I KNOW my fish would have probably lived if the tank didn't have ich, because other local hobbyists (who never saw ich during the entire ordeal) managed to save most of their fish despite operating under the same conditions. It was this experience, more than any other, which finally changed my mind about "ich management", and I decided to prophylactically treat in QT moving forward.
     
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  20. Areseebee

    Areseebee Active Member

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    The problem is that it's really hard to take a single, uncontrolled data point and extrapolate a philosophy from it. Every mechanism of action and detail about what is or is not in the tank (in terms of parasites, disease and immunobiology) is inferred AND based on second hand information. Any piece of counterargument is thrown out as not meeting a standard which is unmeasurable (immunity) so the hypothesis itself ends up being untestable. The percentage of overall hobbyists that actually follow strict QT is pretty small, so there's a huge tendency to fall for base rate fallacies when someone says "I don't QT and I've never had disease".

    I think the most notable thing that comes out of it is: Fish in a stable tank with good husbandry will be resistant of disease. I think this holds true regardless of QT.
     
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