# Treating Hexamita aka Spironucleus



## RD.

*Treating Hexamita aka Spironucleus with Epsom Salt Solution*

This is a rather safe way to treat any newly imported fish, as a prophylactic, just as one would use a de-wormer. It's not only an extremely cheap way to treat fish, the active ingredients are readily available world-wide, and it's also much safer than using most forms of medication. Unlike most medications, there should be no worries about flagellates/pathogens building up a resistance to it, and excess magnesium is easily flushed from a fishes system. In my experience, it's very easy on fish, even very young juvenile fish. The best part - it works! (If the fish has worms when arriving, the epsom salt solution in the feed will also help with purging any worms)

While Metronidazole has always been the drug of choice when combating internal parasites such as hexamita and/or spironucleus, metro (or any other type of medication) should never be used on a regular basis as a prophylactic, and doing so may cause flagellates/parasites to develop a resistance to the medication, and possibly even mutate and become super bugs. It's also been stated by at least one researcher that excessive use of metronidazole can cause organ damage in fish.



> In fish, an excessive use of metronidazole can damage kidneys and other internal organs.(Bassleer, 1983)


Other cons with metronidazole is its solubility in water is very poor, in aquarium settings it has been suggested that it can precipitate out of solution within 6-8 hours, and it can become rather expensive when treating large systems.

While doing some online research on spironucleus I came across an interesting study that mentioned the use of Magnesium sulphate (Epsom salt) in treating internal parasites in angel fish. 
http://scholar.lib.vt.edu/theses/available/etd-120399-140825/unrestricted/ANGEL.PDF

A long read (200+ pages) but the idea of using something as basic as epsom salt to treat internal parasites in fish intrigued me, which in turn lead me to dig deeper.

This is where it got interesting ........

The Israeli Journal of Aquaculture - Bamidgeh 57(2), 2005, 97-104.

http://siamb.org.il/uploads/57_2_Ogut.pdf



> Mortality ceased with application of medicated feed (magnesium sulfate at 3% of the feed) - Hexamita salmonis.





> In early June 2004, a treatment of magnesium sulfate (3% of feed for three days) lowered the parasite load to almost undetectable levels.


In his book; *Fish Disease: diagnosis and treatment*, Edward J. Noga mentions treating hexamita (spironucleus) orally with Magnesium sulphate.

This is certainly encouraging news for anyone who's fish is still eating, or begins eating after treatment with Metro. Not only does Epsom salt assist in recovery when added directly to the aquarium (as per the links above), but according to the research posted above it has a deadly effect on hexamita when ingested.

Dr. Edward J. Noga, MS, DVM, is a highly respected professor of aquatic medicine and immunology, and he has been published approx. 150 times in related papers/journals. His lab at NC State University specializes in the study of infectious diseases of finfish and shellfish. As a side note for Discus keepers, Dr. Noga's book on fish disease is the book that Andrew Soh often refers to for disease/treatment information.

Now for the treatment ......

*For a 3% solution of Magnesium sulphate, add 1 level tablespoon (15 grams) magnesium sulphate to 500 milliliters of distilled water.* Stir, and it's good to go.

Use an eye dropper or pipette to add to pellet food (or any other food that will readily absorb it), and stop dripping water once the pellets become saturated. Use only enough water to saturate the food, with no excess water, so that the water soluble vitamins in the food remain intact. Feed twice a day, for 3-5 days. (I went with 5 days)

In extreme cases, the oral solution could be administered to a fish via a pipette.Just make sure to use a flexible tip so as not to damage the fishes esophagus when squirting the solution down the fishes throat. Only a small amount is required, but repeat daily until the fish is accepting pre-soaked pellets, and continue treatment for 5 days.

My own experience with this treatment ........ so far it's proven to be a life saver, where all other previous 'textbook' methods of treatment for internal parasites have failed, including several days of treating with 500mg Metro per 10 gallons, while feeding Metro soaked food at the same time. (fish was chewing & spitting, but was eating some food twice a day)

In less than 48 hrs of the 3% Magnesium sulphate treatment, for the first time in 30 days the fish was no longer shedding the mucous lining of his intestine. (white/clear feces) After 5 days of feeding the 3% solution via pellets, the fish had made a complete recovery & was back eating like gang busters.

Hopefully some members here will find this information useful.

Neil


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## kelly528

Where exactly does one get magnesium suplhate? I don't think I've heard of it before.

Also interesting, I was on a forum a few hours ago where a member brought up the detrimentally high salt content of Hikari's Metro+. Perhaps this is what puts such a strain on the kidneys?


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## RD.

Magnesium sulphate = Epsom Salt, available at most drug stores, Walmart, etc.


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## Brisch

I always treat with epsom soak before I move to more costly and dangerous teatments. Very cheap, very easy to find and treats so many things.


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## seanyuki

Great info Neil.....for more details Treating Hexamita aka Spironucleus Fish Disease: diagnosis and treatment, Edward J. Noga can be found page 196.

Dr.Noga mentioned these treatments.....page 196
quote

1.Metro oral
2.Metro prolonged immersion
3.Magnesium sulfate oral.......feed 3% Epsom Salt in the feed for 2-3 days(page 288)
4.Raise temperature to 35 degree Celsius for 7 days

unquote


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## RD.

I would have to respectfully disagree with the Dr. with regards to the treatment duration. In some cases a 2 day treatment could potentially leave some of the protozoans intact, only allowing a relapse in the fish if/when it comes under stress again. (most sick fish are already going to be somewhat stressed, and weak from the illness) Even in the study in Israel (linked to above) they stated that their 3 day treatment "lowered the parasite load to almost undetectable levels."

In the case of spironucleus sp IMO when dealing with a sick & already stressed/weak fish it's best to get those levels down as close to zero as possible, which is why I recommended a 5 day treatment. I don't think that the extra 2 days of the 3% magnesium sulphate solution is going to cause any harm to the fish (I would imagine that it's much safer than metro) and the extra 2 days of treatment might be the difference between success, or failure. IME 2 days of treatment turned the fish around, but it took another 2 days before I felt confident that I had won the battle.


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## ibenu

I had gotten an angel fish a few years ago that I had been told was "beat up" by the other angel. New to the hobby I took their word and just gave the fish lots of fresh water and a variety of food. The holes all receded and he was fine for over 2 more years. He was already 3, so after 5 nearing 6 years old the holes returned and I was able to identify it as Heximata. As he had been through a least a couple of bouts of epsom salts ( 7 days in duration) 

I wonder why it didn't cure him only to have it activate when he became geriatric? 

Is it possible ( you've done the reading I have not even looked at the paper) that the salts will always only reduce to undetectable levels and it is not a cure per say?
I acknowledge the possibility he acquired it again due to susceptibility of age but lean more towards a reactivation due to same.


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## RD.

While jury is still out on HITH aka HLLES. (Head & lateral Line Erosion Syndrome) most researchers now agree that it is triggered by stress, which can be a result of many factors. Some of these factors can be easily removed from an aquarium setting (such as nutritional deficiencies), others not always so easy. I also firmly believe that some species are more prone to certain stressors, and that some individual fish have genetically weak immune systems, and can become ill no matter how hard we try to keep them in perfect non stressful conditions. The age of your fish may have been all it took to lower their immune response to these flagellates.

Can one totally erradicate all protozoans from a closed system, probably not, but I believe that one can totally erradicate hex/spiro from the insides of a fish using magnesium sulphate. (when administered orally, not via a "bath")

Feeding a hex/spiro infected fish Magnesium sulphate is not a solution, just a mere tool when these protozoans proliferate to harmful numbers under stressful conditions.

Some excerpts from the articles linked to above that may help explain some of your questions;

Diplomonad flagellates belong to the genera Hexamita and Spironucleus.

Spironucleus vortens appears to the organism responsible for the vast majority of "Hexamita" cases in freshwater tropical species of fish.

Hexamita - cold water species of fish
Spironucleus sp. - Warm water species of fish

It has been suggested that some fish may harbor these parasites in a subclinical state, which can become pathogenic under stressful conditions, such as overcrowding, poor water quality, nutritional inadequacies, etc. Clinical signs of fishes infected by diplomonad flagellates vary from no clinical signs (Mo et al., 1990) to severe symptoms (Kent et al., 1992). Infected salmonids and aquarium fishes may show clinical signs of anorexia, anemia, emaciation, lethargy, hyperpigmentation, fecal pseudocasts, enteritis with excess mucus and yellow watery or jelly-like contents or swollen abdomen (Ferguson and Moccia, 1980; Kent et al., 1992; McElwain, 1968; Mo et al., 1990;

Heavy infections of these diplomonad flagellates may interfere with normal growth of the host by competition with nutrient absorption (Yasutake et al., 1961).

Although Hexamita and Spironucleus cause disease in several economically important fish species in many regions of the world, their pathogenicity is not well known (Woo and Poynton, 1995). It has been believed that the effects and the severity of diplomonad infection are dependent on fish size, tissue site infested, environmental conditions, stocking density, season and stress factors (Allison, 1963; Buchmann and Uldal, 1996; Mo et al., 1990; Uldal and Buchmann, 1996).

It has been suggested that only Spironucleus spp. cause systemic infection because they can invade intestinal mucosa and disseminate to other tissues (Siddall et al., 1992). Evidence of systemic spironucleosis was reported in cyprinids and aquarium fishes (Molnár, 1974), and in salmonids (Mo et al., 1990; Poppe et al., 1992; Sterud et al., 1997). In cyprinids, many Spironucleus sp. were found in the gut where they caused reddening of the mucous membrane, brownish-gray discoloration and necrosis of liver, and haemorrhagic enteritis. In aquarium fishes, the parasite has been reported to cause losses in angelfish stock of up to 50% of the population.

Results indicate that the optimal condition for the in vitro cultivation of Spironucleus vortens is 25°C and pH 6.5 to 7.5 without supplementation with bile.

It has been suggested that high temperatures (above 28°C) can sometimes help in controlling hexamitid infections (Bassleer, 1983). The present study supports this suggestion in that the trophozoites of S. vortens are suppressed and rapidly killed at high temperature. Thus, maintaining higher water temperatures may help decrease the number of trophozoites in the host and might minimize the rate of infection.

Magnesium sulphite (Epsom Salt) will inhibit the growth of these flagellates when used at very high concentrations. (referring to "bath" treatments)

Some random thoughts on this subject from me ......

In "farmed" fish there may be a more limited range of parasites found compared to what is present in the wild, but they are often present in far greater numbers. Hosts are readily available in farm conditions where fish are raised in large numbers, which allows parasitic infestations to grow with no natural check or balance in place. Then factor into the equation that many of these pathogens have mutated due to the overuse and/or incorrect use of various medications, and some of these new "super" strains can be all but impossible to eradicate, short of tearing down ones entire system, and starting over from scratch. I've seen this in large scale fish farms, as well as hobbyist fish rooms. Biosecurity is the latest buzzword in commercial aquaculture, serious business when millions of dollars are at stake, and controlling the introduction of disease is at the top of the list.

Some of form of stress is always the trigger when hexamita/spironucleus become pathogenic, but I think that a very important factor has been missed by many researchers, that being selective breeding. In today's designer fish world, many strains of tropical fish are bred for qualities other than disease resistance and some of these strains may be more susceptible to disease by their actual genetic make up.

How many breeders of flowerhorn do you think focus on disease resistance when attempting to wow the world with their latest greatest new strain of fish? The same could be said for Discus, Angel fish, and many other species that are in demand, where the latest new colors, patterns, fin length, kok size, etc. are what is driving the market. Realistically, disease resistance is most likely at the bottom of some breeders priority list, if it's even considered at all. Nature has it's own way of taking care of genetically weak specimens, man will take those same fish & breed them for profit.

Most of the pathogens found in aquaria can co-exist in harmony with fish, it's typically only under stressful conditions, when a fishes immune system becomes compromised when the parasite gains the upper hand.

Can we control the environment? To a degree, yes. This is precisely where bio-security comes in. With the proper protocol in place one can control, prevent, and even eradicate many of the pathogens found in commercial fisheries. It's more involved than simply keeping ones tank water in pristine condition. The link below is a good overview of what commercial farmers can implement in order to lower the risk factors involved with the introduction and/or spread of disease.

http://www.uwsp.edu/cls/aquaculture/docs/projects/Biosecurity for Aquaculture Facilities 2009.pdf

IMO the key is starting out with a healthy specimen with a strong immune system, followed by keeping the fish in a low stress environment (which includes clean water) and fed a premium diet. Remove any one of those factors from the equation and you will eventually have problems. This is exactly why even when kept under the best of conditions, some fish still succumb to disease. (weak immune system, and low resistance to disease) With these fish one could simply miss a single weekly water change, and it would be enough to upset the natural balance within their system. Yet other fish with stronger immune systems, and greater resistance to disease, can live in what many might consider horrendous conditions, and seemingly thrive.

HTH


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## discuspaul

*Treating Hex*

Question for RD: (Or anyone else who may be able to help)

Found your last week's posts on treating hexamita with Epsom Salts very interesting.
Perhaps you can help me a bit further.

I have a juvie 3" Solid Thai Yellow who hasn't eaten for probably 4 weeks, or slightly more (& can't be enticed), but still looks real good - vibrant coloration - wide open fins - no concave belly.
I treated him/her first with the recommended dosage of Metro over several days - no improvement discernable - followed that up, with a 5 day hiatus, with the recommended dosage of 'Jungle' Parasite Clear - 3 treatments over 6 days - w/temp raised to 88 -90 F. A further week has passed - still not taking food.
Yesterday I again noticed the signs of what I believe to be stomach lining being shed.

Before I take the undesirable (to me) step of attempting to administer ES with some food, orally by pipette, my question is - would it be worthwhile to first attempt an Epsom Salt "bath" - for say, a 3 to 5 day period ?

Pertinent info on other details:
- 55 gal. planted show/growout tank with 5 other 3"- 4" juvies.
The other 5 are doing well & eating voraciously - 
I have 1 larger Red Melon "bully" who is more or less constantly pushing/chasing the others around.
This is no doubt causing the others stress, which I believe was likely the cause of the Yellow's immunity factors weakening/breaking down.
- Temp. now 86 F; PH 7.0 ; always 0 amm. & nitrite; nitrates always maintained < 5; water crystal clear - 50% W/C's every second day.
Fliter media/substrate/tank, etc. cleanliness maintained religiously at least once weekly. Any other info. needed ?
Can anyone help answer this question ?
Thanks in advance for your help.


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## RD.

Emile - when you state;


> I treated him/her first with the recommended dosage of Metro over several days


What was the dosage of metro that you used?


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## discuspaul

*treating hex*

RD
Can't recall - threw out the container when used - was a very small vial of powder form metro bought @ LFS - recommended by the senior, many years fishkeeping, very knowledgeable staff member - if memory serves right, it was the dosage specifically recommended on the label, per gallon, as a bath treatment - 3 X over 6 days (every second day). I did carefully follow the directions fairly precisely, I believe. ( Could it have been 1/4 level tspn. per 10 gals. - can't recall ?) 
As for the Jungle Parasite Clear - metro/prazi - 1 tablet per 10 gal., repeated twice with 48 hours between treatments, with W/C's in between.
Does that answer ?


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## RD.

Metro has been known to precipitate out of solution fairly quickly. In severe cases I treat every day (along with 30% water change) with a "double dose" of metro. (500 mg per 10 gallons) 
For a total of 7-10 days, or until the fish is eating. Some people swear that retreating every 8 hrs (with 500 mg per 10 gallons) is even better. 
Here's a good read where this dosage is mentioned; 
Spironucleus - Hole In The Head, Head and Lateral Line Disease


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## discuspaul

*Treating Hex*

Thanks RD
I will read that link.
Meantime, are you suggesting that perhaps I should treat again, with metro, at the increased dosage outlined, before trying Epsom Salts first ?
Would appreciate your comments.
Emile


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## RD.

Yes, that's what I'm suggesting. (short of getting a vet to examine the fish)

In order for epsom salt to erradicate hexamita/spironucleus (if that is in fact what you are dealing with) the 3% solution (orally) is the only way to go.
A "bath" might help slightly, but according to the angel fish study linked to below it takes a massive amount of epsom salt to work in a bath treatment. http://scholar.lib.vt.edu/theses/available/etd-120399-140825/unrestricted/ANGEL.PDF


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## discuspaul

*Treating Hex*

RD
Thanks again,
If I read your remarks correctly, it doesn't appear that Epsom Salts, at least in a bath treatment, will do much good at this point.
And yes, your view is correct, in that one really doesn't really know if it is hex we are dealing with - but it seems to me it is some form of flagellate/internal parasite causing this condition.
I will obtain more Metro, & attempt a more significantly hefty dosage along the lines you mentioned, and see if that does any good. 
Otherwise, I'm certain I would find an oral administration of medication to be too distateful for me to attempt.
Emile


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## RD.

Correct, I do not believe that an epsom salt bath will be of any help. 
Hit it hard with metro (at 500mg per 10 gallons) and pray to the fish gods. 

Good luck!


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## discuspaul

*Treating Hex*

Many thanks, RD
I very sincerely appreciate your hanging in there with me - your prompt responses were great & have given me some hope for an eventual remedy - it's a beatiful fish that I'd love to have survive.
I'll do another strong Metro push as you suggest & see what develops !
Emile


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## RD.

No problem, glad to help.


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