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I've been combating hole in the head disease (HITH) for a year as of November, and I think I may have found something that works. The reason I'm posting here is that Diana suggested I might pose a question here- and while I still have questions, I thought some more eyes on my proposed "answer" might be of value.

First off, I've been keeping fish on and off for >35 years. I'm an analytical chemist, and I know just enough about water chemistry to make me dangerous. The fish in question are oscars; I've had oscars for years, kept them as a kid, never had a single problem with keeping them.

Now, when I'm all growed up and trying to do right by them (big tanks, better water, etc.), they get sick. With HITH. In different tanks, and independent filtration systems. We didn't have the Internet back when I was young, and the fish pathology texts I had then (Untergasser's book and Post's "Textbook of Fish Health") would just have referred me to hexamita.

I treated with metronidazole, running courses of the stuff for upwards of three weeks with little effect. I improved filtration; my water is now crystal clear, but the HITH reoccurs. I try different foods. I try supplementing feed with vitamin D, vitamin C, B vitamins... all the stuff that the bag says is already in there, but I try anyway because vitamins break down, or the labeling is wrong. Oddly, improving water quality by using RO (my tap water runs >500 ppm TDS) seems to make it worse. I try adding organic carbon in the form of tannins and leaves and peat extract.... no dice.

But, the fish keep eating; they're otherwise healthy. They get deep erosions of the sensory pits, which wax and wane over a 10-14 day cycle. Nothing fits, nothing seems to work.

I do a bit of reading, and- worms are recommended. In fact, "red wiggler" worms (Eisenia fetida) are invoked. I find a local worm farm, their worms are consistent with E. fetida, and... they seem to work. I start supplementing the bagged fish chow (big brand names- Hikari, Dainichi) with Epsom salts (magnesium sulfate), and adding magnesium sulfate to the water, which seems to work... but what really seems to work are the worms.

Of course, the half pound of worm soil I start with only has so many worms in it, and I began to run low. Here's where the story gets interesting: I start making a soil extract from the worm bin, by stirring heaping tablespoons of worm bedding into a half pint jar, then adding RO water. I stir lightly (so as not to kill any worms remaining in the mix), then filter through a paper towel, and dump the "worm tea" (for want of a better term) filtrate into the tank. The filter cake (and any remaining worms) goes back into the worm bin, along with the paper towel filter, which they consume.

If I do this every day or two, no lesions start. If I go 3-4 days, I get the proto-lesions, white spots that invariably erode into the sensory pits. Then I treat with larger volumes of worm tea, and within 24-36 hours, those white spots go away. Instead of forming erosions, the white spots go away....!

Knock on wood, but this seems to be where I'm at now- controlling HITH with worm tea.

I don't know if it's a microbiome thing, an enzyme thing.... worm castings are supposedly good for managing insects because they're full of chitinase, which makes no sense to me because worms are FULL of chitin. The organism that putatively causes HITH (hexamita) is a diplomonad, and- according to a fish pathologist I consulted- there's no chitin in hexamita. Moreover, another fish pathologist I consulted showed me a pathology slide from one of his own fish afflicted with HITH: he could find no hexamita in the affected fish. But metronidazole worked for him anyway.

Anyway- posting this here because I figure Diana comes around now and again, and think maybe she might be interested. I have ultra-filters in the lab that would render the filtrate sterile, so I could run the experiment to see if it's a microbiome thing, and I could autoclave the filtrate to see if it's a nutrient thing since that would denature enzymes as well as render it sterile.

I do not feel this is a 100% cure for HITH in all cases; it seems clear HITH is a syndrome, not a single disease. What works in one instance may not work for another. Perhaps the answer is in the substrate, independent of the worms at all. I'm still very early in testing this, but- knock on wood again- magnesium helps a little, but worms and worm tea seem to help a lot. I just don't know why yet.

Anyone interested in any more detail or have any thoughts on this, please let me know. I've been on the verge of just giving up on oscars, but the worm tea has really turned it around and given me something to try more emphatically.
 

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Try feeding black soldier fly larvae foods like fluVal bug bites. They supposedly have antimicrobial properties but I don‘t know the effectiveness of it especially going through the food process. Metronidazole usually solves the issue.
 
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