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K. Marcia Murphy, DVM, and Gregory A. Lewbart, MS, VMD
Aquarium fish are one of the largest groups of pets kept in the United States. There is an ever increasing demand for veterinary services related to pet fish. Early clinical signs in many infectious and noninfectious diseases of fish are manifested by the skin. In this'article, we have reviewed and described the more common environmental and pathogen-related dermatologic diseases of pet fish. Disease prevention, control, and various treatment protocols also have been discussed.
Copyright 9 1995 by W.B. Saunders Company
Key words: Aquarium, fish, skin, dermatology, disease.
A (bony fishes) consists of an epidermis and
s in all vertebrates, the skin of teleost fish
dermis s u p p o r t e d by a hypodermis or subcutaneous layer (Fig 1). In general, the epidermis is very thin a n d composed, from the inside outward, of a basal layer of germinal cells (stratum germantivum), a variable n u m b e r of layers of cuboidal to squamous cells (stratum lucidum), and an outer cuticle layer.l'2 T h e thickness of the skin and each of its layers varies between and even within species, d e p e n d i n g on age, season of the year, and location on the body. Although some fish do have keratinized surface cells, the outer epidermal cells of fish are usually living a n d do not have keratinized skeletons. 1 T h e cells of the stratum germantivum move upward and outward until they are exfoliated. 2 In addition to typical epithelial cells, a n u m b e r of special cells and structures may be present in fish epidermis. 1'2 These include mucus cells that produce the thin mucus covering f o u n d on the surface of all fish; alarm cells, also known as club cells, which produce a water-soluble substance (a p h e r o m o n e ) that will initiate alert or alarm reactions in other
From the Department of Companion Animal and Special Species Medicine, College of Veterinary Medicine, North Carolina State University, Raleigh, NC. Address reprint requests to Gregory A. Lewbart, MS, VMD, Assistant Professor of Aquatic Animal Medicine, Department of Companion Animal and Special SpeciesMedicine, Collegeof Veterinary Medicine, North Carolina State University, Raleigh, NC 27606. Copyright 9 1995 by W.B. Saunders Company 1055-937X/95/0404-000355.00/0
fish; neuromast ceils, which are multicellular organs of sense (tactile, taste, odor); chloride cells, which function in blood electrolyte exchange; pigment cells; white blood cells, which serve a protective function; and scales, x'2 Just beneath the epidermis, the dermis is composed of a loose layer a n d a compact layer of connective tissue. 1'2 T h e inner portion of the dermis contains blood vessels and lymphatics that nourish the skin. l Fish scales develop within the dermis f r o m osteogenic cells, not epidermally as in reptiles. Because of this, they are not shed regularly but lie in pockets close to the surface, and when a scale is lost, the portion of the epidermis attached to the free surface is lost with it. 2 Scale regeneration occurs quickly and efficiently as long as the osteogenic cell remains viable. Not all fishes have scales. Catfish and m a n y species of eel, for example, lack scales.1 In most teleosts, the dermis also contains pigment cells (chromatophores) that occur in layers at different levels. 1'2 T h e skin color patterns are produced by interactions between the scale types and the various chromatophores; however, in some fish, such as the Red Oscar, the pigment is primarily in the epidermis. 1 T h e color of fish is affected by m a n y normal physiologic and environmental factors including age, diet, temperature, stress, and in some cases, sunlight. 1,2 Colors may fade to some extent during sleep.1 T h e clinician must consider these facts when evaluating a patient because there are also many color changes associated with different disease conditions. W h e n a fish becomes ill, one of the first signs is a change in color. Usually the fish will become d a r k e r dorsally, but a lack of color or an e n h a n c e m e n t of color also may be observed. 1.2 Color change is not the only clinically significant way in which fish skin responds to insults. Increases in mucus production may occur with protozoal infections, and in some instances, when an irritant is present in the water. 1,2 T h e mucus covering contains antibodies (IgM) and lysosomes that are antibacterial, antifungal, and/or antiprotozoal. 1'2 Ulcerations are also
Seminars in Avian and Exotic Pet Medicine, Vol 4, No 4 (October), 1995: pp 220-233
Aquarium Fish Dermatologic Diseases
commonly observed on the skin. They are often red in the center, white on their edge, and black on the p e r i p h e r y / The skin may react with proliferative changes, such as hyperplasia and hypertrophy secondary to protozoan infections, or viral-induced papillomas of saltwater fish and freshwater fish. 2 The skin covers all surfaces of the fish and protects it from the outside environment. The cause of death in fish with extensive lesions of the skin is undoubtedly due to an upset in electrolyte and osmotic balances in the blood, l'2 In fish with superficial wounds, it is very important to determine the salinity of the water in order to interpret the osmotic burden of the fish.t Evaporation can cause salinity to change over time, therefore, it is necessary for the client to regularly check the specific gravity of the water in which marine fish are kept. 3 If ulcerations are extensive or acute, hemorrhage may also play a role. `) Not all skin diseases result in lethal skin lesions, and conversely, not all skin lesions are the result of primary skin disease. In this report, we will discuss the more common skin diseases of pet aquarium fish. Prevention and control are important because it is easier to prevent these diseases than to treat them. See Table 1 for some common treatment protocols.
protocol, and previous medical problems or treatments of the tank. 4-6
The initial contact with the client is likely to be over the telephone and some basic problems can be discussed and potentially solved in this manner. If necessary, the client should be asked to bring the affected fish and approximately 1 L of water (packed separately) from the aquarium into the veterinary clinic. 6 The fish-food containers as well as the boxes or, at least, a written description of the aquarium equipment, such as the heater, filter, and air pump, should be brought in as well. 6 Without question, the major cause of aquarium fish disease and mortality is poor water quality. Therefore, once the client has arrived, the clinician should finish taking the history and test the water. 6 Several comprehensive articles dealing with water chemistry and testing are in the literature and the authors would recommend that the reader refer to those. 4's'9
Sample Collection Techniques
Skin, Fin, and Gill Samples
After the history taking is complete and the water is evaluated, the fish is examined. The physical examination begins with careful observation only; handling the fish should be kept to a minimum. Are the fins frayed? Are there areas of discoloration or depigmentation? Are there visible ectoparasites, ulcerations, or white spots? Is the fish swimming or breathing abnormally?5'6 A positive answer to any of these questions indicates that further diagnostics are necessary. Skin scrapings and routine fin and gill biopsies can usually be p e r f o r m e d quickly and without anesthesia. An anesthetic agent, such as tricaine methanesulfonate, may be required for surgical procedures. 4-6 The agent is purchased in a crystalline form and sprinkled into a container of clean water. 6 After the fish loses its ability to maintain equilibrium it is removed from the water, the desired procedures are performed, and the fish is placed in a "recovery" vessel containing clean water and aeration. 4 Latex gloves should be worn when hart-
The adaptive changes of fish skin and its reaction to insults are a response to its aquatic environment. Most fish are constantly immersed in water. This is an obvious statement but one that must be kept in mind when approaching a fish patient, especially a pet aquarium fish. The fish has literally no means of escape from its captive environment. They feed, excrete wastes, reproduce, and most importantly, respire in it. As with any sick animal, obtaining a complete and accurate history from the owner is essential. 4-6 Stoskopf provides an excellent approach to obtaining a basic history. 7 The clinician will want to know among other things if the client is an experienced aquarist, the social structure in the aquarium, the nutritional plan, quarantine
Murphy and Lewbart
Aquarium Fish Dermatologic Diseases
dling fish to p r e v e n t d a m a g e to the protective mucus layer. Skin scraping. T h e fish is restrained manually or is sedated. A clean scalpel or cover slip is t h e n quickly applied to the area o f interest and the sample (including scales and epithelium) is t a k e n ) T h e tail fin should always be e x a m i n e d because parasites tend to accumulate there. R e m e m b e r that fish skin is very thin and should not be scraped to bleeding. This p r o c e d u r e is not analogous to skin scraping o f dogs and cats. T h e tissue sample, on the tip o f the scalpel, is placed on a glass slide that contains several drops o f clean water (not aquarium water). 4 A coverslip is applied, and the specimen is r e a d y for microscopic examination. Fin biopsy or clip. A fin biopsy can be easily p e r f o r m e d on any o f the larger fins, such as the tail (caudal fin). A small piece o f the fin is r e m o v e d and placed in a few drops o f clean water on a microscope slide and covered with a coverslip to be e x a m i n e d as soon as possible. 4 T w o or three biopsies can be placed on a single slide. Gill biopsy. Removing a piece o f gill tissue is m o r e complicated than obtaining the skin or fin sample owing to the increased risk to the patient. T h e clinician must be careful to remove only a couple o f millimeters o f the prim a r y gill lamellae. 4 T h e r e is usually some b l e e d i n g a f t e r this, b u t it s h o u l d subside quickly. T h e o p e r c u l u m , or gillplate, is deflected, and a few millimeters o f gill tissue are snipped o f f using a pair o f sharp scissors. 4 T h e
gill sample is then m o u n t e d using clean water and a coverslip and e x a m i n e d quickly. H e a l t h y gill tissue a p p e a r s red, a n d the small lamellae are distinct and even. 6 Protozoal and o t h e r ectoparasites are easily observed in any o r all tissue. Some bacteria on the tissue should be considered normal; however, a large n u m b e r o f motile bacteria on the skin a n d gills usually indicate that a problem exists. 6 Because gill biopsy is a risky p r o c e d u r e , if the fish is small or a p o o r anesthetic risk, the clinician should keep in mind that many ectoparasites that affect gill tissue are usually f o u n d o n the skin and fins. T r e a t i n g the parasites o n the skin may also take care o f those on the gills. 4 Gill d a m a g e caused by e n v i r o n m e n t a l p r o b lems can only be evaluated after a gill biopsy has been p e r f o r m e d . 4 Skin Biopsy. Using the same anesthetic protocol and precautions just m e n t i o n e d , w e d g e biopsies o f masses, lumps, a n d / o r ulcerations may be p e r f o r m e d . T h e sample is p r e s e r v e d in f o r m a l i n a n d submitted for histopathology. D e p e n d i n g on the etiology and ability to attain a representative sample, the clinician may be able to obtain a diagnosis on a live fish.
Selected Fish Skin Diseases
Fish live in an e n v i r o n m e n t that is full o f disease-causing organisms and parasites3 Wild fish usually have a low b u r d e n o f a wide variety o f parasites w h e n they are captured, frequently without showing any signs o f disease. 10
Figure 1. This H&E stained section through the skin of a striped bass (Morone saxatilis) shows the cellular
epidermis overlying the darkly stained bony scale. The thin dermis lies beneath the scale. The sandwiched configuration of this section is due to the fact because, in most fishes, the scales overlap one another, creating the appearance of epidermis overlapping epidermis. (Photomicrograph by Lester Khoo.) Figure 2. A silver dollar (Metynnis sp) with a severe case of"Ich." Note the numerous pinpoint white spots on the skin and fins that represent encysted trophonts of Ichthyopthirius multifiliis. (Photograph by Todd Wentzel.) Figure 3. This H&E stained section of catfish skin shows an encysted "Ich" trophont. Note the lack of scales. (Photomicrograph by Lester Khoo.) Figure 4. This red pacu (Colossoma brachypomum) was attacked by a tankmate which damaged the protective epithelium and mucus coating. A secondary Tetrahymena infection caused most of the tissue erosion seen in this picture. This fish survived with intensive antibiotic and salt therapy. Figure 5. A goldfish with clinical signs of bacterial fin rot. Note the frayed fins, epithelial necrosis, and exposed bony fin rays. Figure 6. A koi (Cyprinus ca~pio) with an ulcer typical of those found with Aeromonas salmonicida infections. Figure 7. A common goldfish (Carassius auratus) with an undifferentiated sarcoma. Such tumors are not uncommon in goldfish. This tumor was removed surgically. Figure 8. This fire eel (Mastacembelus erythrotaenia) became entrapped in a small hole drilled into the side ofa PVC pipe shelter. A deep necrotic lesion resulted from the traumatic event.
Murphy and Lewbart
Parasites derive their living from another organism, the host, and provide no benefit for the host. 2 Protozoa, trematodes, and crustaceans are among the many parasites that infect both freshwater and marine fishes.
tifiliis is one of the few fish parasites with cilia
surrounding the entire organism. 1,9 Eradication of I multifiliis is possible only during the free-swimming infective stages, since medications cannot penetrate to the encysted theronts. 1'2'1~ Malachite green, formalin, and malachite green-formalin mixtures have all been used to treat freshwater fish. 11 Common salt was successfully used to treat experimentally induced I multifiliis in warmwater fishes. 12 In addition to chemotherapy, management adjustments also help to control infestations. Elevating the water temperature to several degrees above normal for 5 to 7 days will limit the infection by adversely affecting the heat-sensitive theronts, accelerating the parasite's life, and enhancing the immune system of the host. 1'2'11 However, attention must be paid to temperature and pH regulation to avoid stressing the fish. 9 Heavy filtration with diatomaceous earth filters will also decrease the number of circulating theronts. 1'2 A third management strategy is to transfer the fish to a clean "hospital" aquarium every day for 7 days, limiting reinfection by the theronts. 1'2 In home aquaria where the medicants may harm plants, removal of theronts can be achieved by making heavy water changes daily or, alternatively, the fish may be treated in a separate aquarium equipped with a heater and filter. T h e protozoa in the main aquarium will eventually die owing to lack of a host. 1,2 To be absolutely sure that the theronts are eliminated, have the client make at least one complete water change, along with removing debris from the gravel, and elevate the temperature several degrees above normal before returning the fish to the main aquarium. 1'2 Cryptocaryon irritans is the counterpart to I multifiliis in saltwater fish and is often called "marine ich" or "crypto." T h e predominant signs of the disease in marine fish also includes whitish-gray noduies on the skin and/or gills, as well as fusion of the gill lamellae, epithelial hyperplasia, hemorrhages, and lesions of secondary bacterial infection. 1'5 The trophonts (feeding stage) burrow vigorously into the epithelium causing extreme irritation. T h e result is scratching or flashing, excess mucus production, and an increased respiratory rate. 2,5 The life cycle of C #,itans is similar to that of I multifiliis, and the treatment methodology is iden-
Protozoans are the most ubiquitous parasites that infect tropical pet fish. They also cause the most damage. Fortunately they are easily diagnosed and, in general, are readily treated. 10,t 1
Ichthyophthirius multifiliis/Cryptocaryon irritans. Ichthyophthirius multifiliis, a ciliate, is the
most familiar protozoan to aquarists and clinicians. It is the cause of "Ich" and affects most freshwater fish species worldwide. U n d e r aquarium conditions it is very virulent3 1 multifiliis has a simple life cycle that involves one true host, the fish. The theront matures in the skin of the fish and becomes a trophont. The large trophont (visible as small whitish-gray nodules on the skin and gills [Fig 2]) breaks through the epithelium of the host and falls to the bottom of the aquarium. It is now called a tomont. The tomont undergoes mitosis, which, within 18 to 21 hours at 23 to 25 ~ C, produces hundreds of ciliated, infective tomites. The infective tomites, once released into the water, are referred to as theronts. They must find a fish host within 2 to 3 days of" release or the theronts will die. Once an infective theront attaches and actively penetrates the skin and/or gill epithelium of the fish, it develops into a reproductive trophont, completing the life cycle (Fig 3). The entire "Ich" life cycle takes between 2 to 4 weeks, depending on the water temperature. 1'2'1~ It is important to note that the infective theronts may become attached to plants or other debris for a day or two, thus, the aquarium decor may act as a disease vector when moved from one tank to another without a period of quarantine.21 The predominant signs of the disease include small white spots over the body and/or gills. Diagnosis is confirmed by microscopic examination of skin scrapings and/or fin and gill biopsies. The theronts are large, may appear round to oval, and move across the field of view in a rolling motion. A characteristic crescent-shaped nucleus is often visible. 1'2'11 1 mul-
Aquarium Fish Dermatologic Diseases
tical except that copper sulfate or copper and f o r m a l i n are used r a t h e r t h a n malachite green.l'5 Cytolysis of C irritans tomonts occurs at salinities of 16 parts per thousand (ppt) or lower; therefore hyposalinity is suggested as an alternate method of treating infestations of euryhaline species of fish. The optimum conditions for tomont development are 30 ~ C at a salinity of 31 ppt.1
Tetrahymena pyriformus/Uronema marinum. Tetrahymena pyriformus is a facultative
pathogen of freshwater fish. This ciliate normally feeds on debris at the bottom of the aquarium and only becomes pathogenic when the fish are overcrowded or stressed.ll An increase in organic matter, including decaying food, exacerbates the problem. 1'2'11 T pyriformus is frequently a secondary or tertiary invader of lesions initiated by other parasites and/or bacteria. 1'2 The skin of affected fish may show signs of necrosis (whitish areas) surrounded by hemorrhages. Occasionally the tissues surrounding the eyes are invaded, resulting in exophthalmus.l'2 Diagnosis is confirmed by wet mount preparations that show hundreds of actively mobile, pear-shaped ciliates. 1,2,11 T pyriformus has been called "guppy killer" because once a fish has become infected, treatment is nearly impossible as it burrows deep into the tissues of the host (Fig 4). The best form of treatment is control and prevention; which appears to center on maintaining excellent water quality and removing uneaten foods.l,2,11 Baths with formalin or other external parasiticides may reduce the external parasites but will have no effect on the internal
o n e s . 1,2
parasite gains entrance into the host, but it is believed to be related to the debilitating effects of adverse environmental conditions on the host's immune system.1 Once U marinum does establish itself within the fish, tissue destruction is rapid and death quickly follows. 1 Unfortunately this protozoan is difficult to eradicate, especially if the disease is in an advanced stage and the parasite has burrowed under the skin. 2 Parasiticides (formalin/malachite green) in combination with freshwater dips have been used, along with adjuvant therapy, to control the secondary bacterial infection. 2 As with T pyriformus, the best form of treatment is prevention and control. 1'2
Oodinium pillularis/Oodinium oeellatum. Oodinium pillularis is a dinoflagellate and the
causative agent for "velvet disease" in freshwater fish. The principle sign of infection is a fine dusty-gold/brown appearance on the skin and gills of the fish. 1'2'I~ Red, yellow, brown, or green chlorophyll contained within the cell cytoplasm of the organism is responsible for its color, l~ The life cycle is reminiscent of" Ichthyophthirius in that the Oodinium cells feed on the fish epithelial tissue and, when mature (encysted), drop off the fish, undergo multiple divisions, and release motile infective stages that must find a host within 24 hours or die. Once the flagellated infective stage has attached to a host fish, the flagellate drops off and the parasite matures. 1''2'11 The entire cycle takes approximately 10 days. 1 Diagnosis is made by viewing wet mount preparations of skin and fin scrapings and/or gill biopsy, which show pear-shaped cysts containing maturing dinospores. The cysts are attached to underlying tissues. 1,2 The marine counterpart is Oodinium ocellatum (Amyloodinum ocellatum). It is responsible for "velvet disease" of saltwater fish, also known as "coral fish disease" among many other names. 1.2.11 The life cycle and pathology are similar to that of its freshwater "cousin."" In severe infections, ulcerations and excess mucous may become evident, as well as flashing or frequent scratching on the aquarium bottom or coral. 1'2 The treatment of both fresh and saltwater Oodinium species involves the use of copper-based medications for a period of 10 days. 1'2'5 Reinfection is a common problem and may be associated with the parasite's ability
Uronema marinum is an opportunistic ciliate that invades the internal organs of captive saltwater fish. It is the marine counterpart to T pyriformus. Lesions begin as small discolored areas on the skin surface that eventually spread and ulcerate. 2 Pseudomonas bacteria usually invade the lesions and may be responsible for the death of the fish. 2 Aneurysm of the gills and sloughing of the epidermis are common.1 Diagnosis is based on clinical signs and confirmed by skin scrapings and fin and gill biopsies. Microscopic examination of the tissue samples will demonstrate pear-shaped, highly motile ciliates with a single oval macronucleus and a single micronucleus. 1'2 It is uncertain how the
Murphy and Lewbart
to colonize not only the skin and gills, but also the intestine. 1'2'11 This disease is c o m m o n in marine and freshwater aquaria.
Epistylis. Epistylis species (Heteropolaria colisarum) are stalked ciliated protozoans that
parasitize freshwater tropical fish. T h e r e is no known marine counterpart. Normally Epistylis are nonpathogenic and are f o u n d attached to v e g e t a t i o n a n d c r u s t a c e a n s in t h e a q u a r ium. 1&11 However, if the aquarium is high in organic matter, they will proliferate a n d take advantage of stressed or debilitated fish. These protozoans are most frequently observed on goldfish as well as bottom-dwelling o r n a m e n t a l catfish. 1'2'11 Gross lesions appear as a white area or white tuft (resembling fungal infection) on the surface of the fish body a n d / o r fins. Epistylis have also been isolated in ulcerated areas from which Aeromonas hydrophila has been cultured. It is u n k n o w n which organism initiated the problem. I'2'11 Diagnosis is c o n f i r m e d by m a k i n g wet m o u n t preparations from the affected areas. Characteristic bell-shaped ciliated organisms, which periodically contract from an elongated f o r m to a ball-shape form, are observed. 1'2'11 Epistylis are easily treated with standard parasiticides or by swabbing the affected areas with tincture of iodine or a povidone iodine solution. However, the p r o b l e m can be easily avoided by regular cleaning of gravel a n d careful feeding to minimize the buildup o f organic matter. 1,2,11
Chilodonella cyprini/BrooklyneUa hostilis.
Unlike the previous p r o t o z o a n s discussed, there is no c o m m o n n a m e for Chilodonella cyprini infections. It is an u n c o m m o n problem in the h o m e aquarium because the infestation would initially be encountered at the wholesale and retail level, where it is a severe and comm o n p r o b l e m o f f r e s h w a t e r fishes. 1"2 Very high morbidity and mortality may occur u n d e r stressful, crowded aquarium conditions. 11 T h e principle signs of C cyprini are respiratory distress, clamped fins, depression, and excessive mucus production. 1'2 Skin scrapings and gill biopsy samples show an oval, flattened ciliate with a shape suggestive of a valentine heart, which moves in a characteristically slow circular fashion, a'2'11 Wet mounts must be examined immediately because the parasite dies quickly on a microscope slide. 1,11 ChilodoneUa is susceptible to commonly used parasiticides or 0.3% salt a d d e d to water. Both t r e a t m e n t regimens will kill the parasites on the fish as well as in the water. 1'2AI Brooklynella hostilis is a highly lethal Chilodonella-like obligate parasite on the gills and skin of marine fish. It appears to be more comm o n in h o m e aquaria than its freshwater counterpart, although stressful, crowded conditions are also i m p o r t a n t in the pathogenesis o f B hostilis. Clownfish and seahorses appear to be particularly susceptible and exhibit clinical signs as previously mentioned. 2 Body lesions begin as small, diffuse, discolored foci that involve a large portion of the fish's body. 2 As the disease advances, massive h e m o r r h a g e and epithelial sloughing occurs. 1'2 Death is likely caused by the loss of e p i t h e l i u m a n d s u b s e q u e n t imp a i r e d o s m o r e g u l a t o r y capabilities o f the fish. 1'2'5 Diagnosis is made by wet m o u n t examination of fish and/or gill smears. T h e ciliates are bean- to heart-shaped and glide on their ventral surface. 1'2 T h e y contain an oval macronucleus, several micronuclei, and multipie food vacuoles. 2 B hostilis is resistant to copper medicants, therefore, a combination of malachite green and formalin is r e c o m m e n d e d for treatment. 1'2'5 In most cases, antibacterial therapy also is necessary to control secondary topical or systemic bacterial infections. 2
Monogenetic trematodes or flatworms are c o m m o n parasites of the gills, fins, a n d skirl of" both freshwater and saltwater aquarium fishes. T h e y feed on mucus, skin, and sometimes blood. T h e most damaging aspect to the fish is the haptor, or attachment organ, which bears two large centrally placed hooks and an assortm e n t of up to 16 s u r r o u n d i n g hooklets. 1'2'5'1~ Dactylogyrus/Gyrodactylus. Two main families parasitize both freshwater a n d m a r i n e tropical fish, Dactylogyridae (gill flukes) and Gyrodactylidae (skin flukes). O v e r c r o w d i n g and poor husbandry are often associated with an epizootic occurrence of these parasites. 1.9,10 O f the many genera, Dactylogyrus is the most important. It is associated primarily with the gills, causing hyperplasia, destruction of the gill epithelium, and clubbing of gill filaments, resulting in asphyxiation. 1'2 Gyrodactylus also commonly infects aquarium fish and is associated
Aquarium Fish Dermatologic Diseases
mainly with the skin, a l t h o u g h the fins a n d gills m a y be involved as well. I n a p p a r e n t Gyrodacty/us infections occur. W h e n lesions are present, they m a y include localized h e m o r r h a g i c areas, excessive m u c u s p r o d u c t i o n , a n d localized ulcerations. 1'2 T h e a f f e c t e d fish o f t e n have a r a g g e d - a p p e a r i n g tail f r o m localized h y p e r p l a sia, necrosis o f the tips o f the fins, a n d loss o f epithelial cells. 1,9,10 S e c o n d a r y bacterial infections are c o m m o n . T h e b e h a v i o r o f affected fish ranges f r o m flashing o r r u b b i n g to b e c o m ing inactive at the b o t t o m o f the a q u a r i u m . Rapid r e s p i r a t o r y m o v e m e n t s also m a y be observed. 1,9
Table 1. Treatment Table
T h e diagnosis o f b o t h g e n e r a involves skin scrapings, fin, a n d / o r gill biopsies; the w o r m s are readily a p p a r e n t . l ' 2 T r e a t m e n t consists o f the c o m m o n parasiticides, or saltwater baths for f r e s h w a t e r fish a n d f r e s h w a t e r baths f o r saltwater fish. Resistance p r o b l e m s have develo p e d with the o v e r u s e of o r g a n o p h o s p h a t e s , but praziquantel (as a bath or i m m e r s i o n ) has b e e n used successfully to t r e a t gyrodactylid trematodes. 1,2 Neobenedenia meUini. M a n y species o f marine tropical fish are also susceptible to the m o n o g e n e t i c t r e m a t o d e Neobenedenia mellini (Epibdella mellini). U n d e r a q u a r i u m conditions,
Acetic acid (Glacial) Copper sulfate
Dosage and Treatment
Dip treatment of 2 mL/L of water for 30 to 45 seconds. 0.18 to 0.22 mg/L for 14 to 21 days.
Comments (Indications, Concerns)
Ectoparasites. May kill small or debilitated fish. External ciliates, dinoflagellates, some monogenea of marine fish. Toxicity, decreased immune function. Many gram-negative bacteria. External fungal and parasitic infections. Carcinogenic, handle with care. Water must be well aerated, and fish must be closely monitored. Most ectoparasites, especially "Ich." May use in combination with 20 p p m formaldehyde. May repeat treatment next day after 30% water change. Localized fungal infection. Potential toxicity, may burn skin. Some Monogenea. May cause central nervous system dysfunction (terminate dip).
Enrofloxacin Formaldehyde (37%)
Bath of 2.5 mg/L of water for 5 hours, repeat as necessary. Bath treatment of 20 to 25 ppm for 12 to 24 hours or I00 to 250 ppm for 30 minutes to t hour. Bath treatment of 0.1 to 0.15 ppm for 12 to 24 hours, repeat as necessary. 1:10 dilution, topically. Bath of 5 to 10 mg/L for 3 to 6 hours, repeat with 30% to 70% water changes between baths. Use 10 to 20 ppm as an indefinite tank treatment. Decomposes over time. Apply topically, twice daily, as needed. 100% seawater dip for 5 minutes or longer, depending on the tolerance by the fish. Bath of 960 mg/38 L of water for 3 to 6 hours, repeat as needed.
Povidone-iodine preparation Praziquantel
Oodinium and tomite stages of
"Ida." Some species of fish may be sensitive, test before use. Bacterial infections. Works only on freshwater fish. Marine fish may be treated similarly in a fresh water dip for 5 minutes if they tolerate it. Bacterial infections. Treat until signs of disease are gone. Safe for most fish species.
Silvadene (Marion, Kansas City, MO) Sodium chloride (3.0%)
Murphy and Lewbart
it parasitizes the skin and gills of saltwater fish. The fish show signs of respiratory distress, irritation (frequent scratching on objects), and the body color pales. 1'2'5 Mechanical damage and ulceration of the skin leads to secondary bacterial infections. 1'2 The diagnosis is confirmed by observation of the worms in wet mount preparations of skin scrapings and gill biopsies. Freshwater dips will effectively control N mellini, although organophosphates, praziquantel, and formalin have also been used. 1,2,5
are apparent around the area of the sting. Ulcerations often develop and are believed to be the result of secondary bacterial infections (Aeromonas, Pseudomonas). 1,2,10 The wounds are also frequently infected with fungi.l'2 T h e affected fish will be observed to scratch repeatedly on the aquarium bottom or any available object. 1'2'1~ Diagnosis is made by examining the live fish for the small, dorsoventrally flattened parasite. Argulus is t r a n s p a r e n t and tends to take on the color of the fish it is parasitizing. Both organophosphate and formalin treatments may be successful, although antibiotic therapy may also be required. 1,2
Lernaea. Copepods of the genus Lernaea are easily recognized crustacean parasites of the fish skin. They are not host specific but are particularly common in goldfish. 2 They are commonly called "anchorworms" because the female anchors herself to the fish by burrowing into the dermis with her head. The female also has a wormlike appearance and, at her maximum length, a characteristic V shape owing to the two eggs sacs that protrude from the free end of her body. 1,2 Irritation and localized hemorrhagic reactions occur at the point of entry of the anchorworm. These areas may develop into ulcerations and then fibrous nodules, as well as allow for secondary bacterial or fungal infections.l'2'10 The parasite is easily diagnosed on physical examination of the affected fish. Treatment involves dipping the freshwater fish into a saltwater aquarium for 5 to 10 minutes per day. The anchorworms will eventually turn a greenish color, wither, and be expelled from the fish. 2 If only a few fish are involved, the worms may be removed using forceps, taking care not to break the worm. 1,2 Juvenile forms must also be eliminated from the water using organophosphates or formalin with successive water changes. Antibiotic treatment may also be necessary. 1.2 Argulus. Another external crustacean that affects aquarium fish is Argulus, the fish louse. This large parasite can be easily seen with the naked eye moving along the surface of both freshwater and marine tropical fish. 1'2'I~ The fish louse uses both suction cups and a pair of curved hooks to attach to the fish, inserts its proboscis into the epidermis and underlying tissues, and feeds by injecting cytolytic toxin through the stiletto. 1'2 Severe local reactions
The billions of bacteria contained in an established aquarium can be divided into three main groups. The first, and largest proportion, are normal flora. They live benignly in the environment and include a group of bacteria responsible for the decomposition of wastes (nitrifying bacteria). 2 T h e second group, opportunistic bacteria, can cause disease under a given set of conditions. This usually involves some factor in the aquatic environment that weakens the fish, compromising its immune system and rendering it open to successful bacterial attack. 2 The third, and smallest group, are the primary pathogens, which are only occasionally present. These microorganisms have the ability to cause disease in normal healthy fish. 2 Because p r i m a r y pathogens are seldom encountered in fish culture, most bacterial disease programs center on controlling the opportunists, and more importantly, maintaining the inherent immunity of the fish. 2 The physical signs associated with bacterial infections include hemorrhages, ulcerations, and skin and fin erosions (Fig 5). Hemorrhages are common and may vary from petechiae (pinpoint) to ecchymotic (paintbrushlike reddened areas). 2 Ulcers are distinct, often circumscribed areas of skin where a ring of reddened tissue surrounds a central core of dead tissue. Erosions appear as white areas and are usually caused by a bacterial enzyme that destroys the tissue (Fig 6). 2 The tentative diagnosis of a bacterial problem should always be preceded by attempts to identify stress factors that
Aquarium Fish Dermatologic Diseases
may have weakened the fish. These include poor water quality, long transport time, poor nutrition, or the presence of a concomitant parasitic infection. 2'9 When an etiologic diagnosis is necessary, a sterile sample is best collected from the kidney for microbiological culture. Skin lesions may be cultured, but the results are often misleading owing to mixed culture results, including nonpathogens. 9 Most bacterial pathogens of tropical fish are gramnegative rods and include the genera Aeromonas, Pseudomonas, Vibrio, and F lexibacter. 1'2'5'9"1~ Aeromonas hydrophila. Aeromonas hydrophila is a common cause of bacterial infection in the fish. It is an opportunistic pathogen with disease outbreaks after a period of stress and/or infestation with parasites that provide a route of entry.l'2 Early lesions may include petechial and ecchymotic hemorrhages in and around the gills and anus, at the base of fins, and within the mouth. In advanced cases, the lesions develop into large ulcers. ~'2'1~ A cytotoxin produced by A hydrophila is believed to play a role in the pathogenesis of the disease. 13 Treatment involves the use of antibiotics; however, resistance does develop easily in A hydrophila strains. 1'2 There are reports that fluoroquinolones are an effective treatment of this microorganism.14 A commercial bacterin is not yet available. Problems related to A hydrophita are rare in well-managed home aquaria where fish are fed a well-balanced diet.l'z Pseudomonas fluorescens. Pseudomonas fluorescens is a dominant, normal inhabitant of both freshwater and marine aquaria. All species of aquarium fish are susceptible to this opportunistic pathogen and, in all cases, infections are believed to be related to s t r e s s / T h e clinical signs are identical to those associated with other bacterial infections. They range from fin and body ulcers to erosions. The tissues surrounding the ulcers are not usually hemorrhagic, although petechiae and ecchymoses may be p r e s e n t elsewhere on the body. 1'2 This differs from the ulcerative lesions related to A hydrophila infections. Amazingly, affected fish may continue to eat, despite extensive lesions, including exposed skeletal structures. 1 Death does occur in peracute and severely advanced cases. 1'2 Treatment is difficult because several Pseudomonas strains are resistant to many antimicrobial drugs. 2 Although
fluoroquinolones have been reported to be effective against a number of bacterial fish pathogens, we are unaware of its efficacy against fish Pseudomonas specifically. 14 No bacterins are available ibr this disease. Vibrio. Vibrio is the most common and serious bacterial infection of saltwater fish. Although all freshwater and saltwater fish species are considered susceptible, it is more likely to be found in the marine environment.~'2'5 It is an opportunistic pathogen with infections occurring in fish after periods of stress, 2'5 especially when the tank water becomes warm and dissolved oxygen is decreased. 1 The typical external lesions include erythema and bloody infection of the mouth, vent, and at the base of the fins; red necrotic lesions of the abdomen; ulcerations; and fin and body erosions, l'2'a The necrotic lesions may extend into the musculature as the disease progresses, resulting in a loss of body fluids. 5 The affected fish rarely eat and are lethargic and depressed.1 Chemotherapeutic options are limited because of the usual loss of appetite, although some antibiotics may be injected into larger fish or added to the aquarium water. ~'2 An effective commercial vaccine is available but is mainly used for food-producing species. 2'5 In a well-managed saltwater aquarium where fish are kept in good nutrition and good water, vibriosis is rare.l'z Flexibaeter eolumnaris. In contrast to the previously discussed bacteria, Flexibacter columnaris (Cytophaga columnaris) may be considered a primary pathogen of fish. 2"~~It produces the enzyme chronditinase and is capable of initiating a disease known as columnaris disease in healthy fish. 2 T h e marine counterpart is known as Flexibacter maritimus. The skin infection is characterized by blanched, necrotic lesions of the body, the most distinctive of which is a saddlelike marking behind the dorsal fin. The fins and tail of some affected fish will develop whitish areas and split. The gills may also display necrotic ulcers. 2'1~ Unlike the previous three bacterial pathogens, internal involvement is uncommon with Flexibacter infections, although concurrent infections with other bacteria, such as Aeromonas, may occur, z When lesions are observed on the fish, antibiotics should be used immediately. Flexibacter is considered a primary pathogen, but environmental stresses do appear to play somewhat of a
Murphy and Lewbart
role in the disease process. In aquarium fish, it is often observed immediately after shipping, and in well-managed home aquaria, it is an uncommon disease. ~ Columnaris disease can be controlled through the reduction of environmental bacteria by minimizing the amount of organic matter in the aquarium. No vaccine is available for this disease. 2
vere, many fish will heal with supportive care (good nutrition and clean water). 9 Several chemotherapeutic options are available including copper sulfate, malachite green, formaldehyde, and sodium chloride baths, among others.l'2'9 In general, an established fungal infection is difficult to treat. Management practices must be improved, and the other pathogens present must also be addressed. 1.2
The most commonly identified fungal pathogens are members of the Saproleg~zia genera. They are ubiquitous water molds found in both freshwater and saltwater, although they are primarily a freshwater problem. 1.2,10 Their growth is favored by moderately acidic pH, low temperatures, and the presence of decaying organic material. 1'1~ Saprolegnia fungi rarely p e n e t r a t e d e e p l y into muscle but instead spread mainly along the surface of the body. By contrast, hyphae grow rapidly into dead, excised fish tissue. 1,15 This suggests that potent defenses normally prevent deep invasion. 1~ Fungal disease in fish is nearly always secondary to a break in the integrity of the epidermis and associated mucus coating. 9 Mucus is considered an important barrier to oomycete colonization. T h e majority of Saprole~ia spores that land on healthy fish skin are quickly sloughed or die.15 Various forms of stress including transport, handling, poor water quality (especially increased organic matter and decreased temperature), and poor nutrition are considered necessary in the development of water mold infections in fish. 1'2'15 The typical clinical appearance is white cottonlike growths randomly distributed over the surface of the skin and gills. The cottony appearance is only present when the fish is in the water. Once the fish is removed from the water, the mass collapses resembling a ball of wet cotton. 1,2 Focal epidermal erosions may be evident and are directly related to tissue necrosis in the area of the hyphae.1 Affected' fish will become anorectic and inactive. 1~ Death is caused by impaired osmoregulation and the fish's inability to maintain body fluid balance. 1'2 T h e diagnosis is readily made with quick skin scrape and examination of the wet mount preparation. If the infection is not se-
Reports of fungal disease in marine fish are sporadic with the exception oflchthyophonus hoferi disease (sandpaper disease). 1 Fish become infected after eating food containing viable I hoferi spores. 1'5 The external lesions may include skin discoloration and multiple white papu|es. In fine-scaled species of fish, a rough, granular appearance of the skin may be evident caused by multiple subcutaneous granulomas. Some fish will develop a dark color in the lateral line that progresses to complete darkening.l'5 Visualization of granulomas containing round and elliptic cysts in a wet mount preparation will confirm the diagnosis. 5 There is no chemotherapeutic regimen documented for this disease, and the use of systemic antifungal drugs is experimental. Prevention includes eliminating fresh fish from the diet and removing dead and dying fish from the aquarium. 1,5
More than 50 basic types of tumors, ranging from benign epidermal papillomas to metastatic melanomas, have been registered in more than 300 species of fish. Tumors of the skin account for almost 50% of these, however, the overwhelming majority of these occur in wild fish. 16 Other than tumors of goldfish (Fig 7), which are well represented in the literature, few tumors are reported in tropical freshwater or marine fish.l'2'17 O f the naturally occurring fish tumors, benign epidermal hyperplasia and papillomas are the most frequently observed.16 The causes of fish skin tumor development are varied and suspected to be multifactorial. There is some evidence that irritation of the skin caused by constant mechanical damage (scratching) or parasitic encystment may lead to tumorous growths. 16 Viruses are also believed to play an important role in the induc-
Aquarium Fish Dermatologic Diseases
tion of skin tumors in fish. Viruses and viruslike particles identified in benign tumor tissue of fishes were (most frequently) herpesviruses and (less frequently) adenoviruses, retroviruses, rhabdoviruses, birnaviruses, or picornoviruses. In malignant forms, like sarcomas or lymphosarcomas, evidence was linked to retrovirusesJ 6 To date, the significance of the viruses and viruslike particles is mostly speculative. 16 Clinically, because the majority of fish skin tumors appear to be benign, surgical resection may be curative as well as diagnostic. Any unidentified mass removed from the fish should be submitted for histopathologic examination.
commercial products designed to adjust pH parameters available through pet stores.
In cases of chronic acidosis, a decrease in pH, fish will develop excess mucus production and inflammation of the skin, which is often reported by the client as a milkiness.1 The gill epithelium will erode, and gill hemorrhages are common. Hemorrhages of the skin also may occur, but more often the owner will note that the fish was in excellent condition with its colors brighter than usual, and then it was found dead at the bottom of the aquarium, still in excellent colorJ In a closed aquarium, the pH of the water tends to decrease gradually with the input of fish waste products and the activity of the nitrifying bacteria. 1,9 The usual corrective measure is partial water changes with alkaline waterJ '9 If the local water supply is acidic (not common), sodium bicarbonate can be added to increase the buffering component of the system. A third approach, in an emergency situation, is to aerate the water vigorously to expel carbon dioxide. With chronic alkalosis the gills are pale, and skin erosions along with increased mucus production are frequent complaints. Gill necrosis is not usually appreciated until postmortem. ~ Filtration of water through peat will acidify the water for changes and can be used in areas where the water tends to be alkaline. In some tanks, the addition of hydrochloric acid routinely occurs to lower the pH, but it is not a long-term solution. 1 T h e r e are n u m e r o u s
Supersaturation Supersaturation can be the result of abnormal accumulations of any gas in aquarium water, the most common offender being nitrogen gas. 1 Affected fish will have gas under the skin of their fins, body, and mouth, leading to the descriptive name of the resultant syndrome, gas bubble disease) '2 Severe problems occur when gas bubble formation in capillary beds causes ischemia and tissue necrosis. 1 T h e causes of supersaturation include a leak in a hose or an increased accumulation of oxygen caused by heavy plant and/or algal growth. 1'2 Excessive aeration from airstones does not usually but can contribute to the syndrome.1 Vitamin E Deficiency The requirement for vitamin E in the diet of terrestrial animals is well d o c u m e n t e d , although a demand for this nutrient in fish has only been demonstrated in a few cultured species. 1'18'19 The accidental feeding of a vitamin E-deficient diet to a group of goldfish resulted in progressive fraying and deterioration of the tail and then the fins. At the terminal stages of the disease, an external fungal infection developed, and the fish died. The clinical course of onset to death was 7 days or less, with 90% to 100% morbidity, and 20% mortality, is Some of the affected fish also showed signs of epidermal necrosis, likely secondary to bacterial infection, as skin scrapings showed Aeromonas hydrophila, Pseudomonas species, and Citrobacter freundii. Correction of the vitamin E-deficient diet resulted in immediate and p e r m a n e n t clinical improvement and a drastic reduction in mortality. 18 Head and Lateral Line Erosion Syndrome Head and Lateral Line Erosion Syndrome (HLLE) is a common syndrome of marine species kept in captivity. 2~ The clinical lesions of affected fish include superficial erosions of the head and face that progress down the lateral flank to involve the lateral line. The clinical disease is usually nonfatal but can result in permanent scarring of the skin surface.1'20 A primary cause of HLLE has not been discovered,
Murphy and Lewbart
although environmental stressors such as poor water quality, inadequate nutrition, and the presence of opportunistic pathogens appear to be involved. 1'2~ Treatment with antimicrobials alone is unsuccessful, however, resolution of the lesions may be observed with vitamin C supplementation or elimination of activated charcoal from the filtration systems. 1,20 Recent reports of a reovirus isolated from a moribund angel fish displaying the initial lesions associated with HLLE may support the theory of an immunocompromised state existing in fish affected with HLLE. 2~ Aquatic reoviruses tend to have a low pathogenicity and are generally found in association with stress-related disease outbreaks. Further in vivo studies will be necessary to establish an etiologic link between HLLE and the reovirus. 2~
Prevention and Control
Preventative medicine is always the best medicine. This is especially true when dealing with pet fishes, whether they are freshwater or marine varieties. The logistics of treating captive fish is often difficult and may be costly in terms of the value of the fish, necessary equipment (extra tanks, heater, etcetera), and time. 21 An extensive review of all of the components of proper preventative fish medicine is beyond the scope of this report. The authors would r e c o m m e n d that any clinicians involved in treating pet fish patients consult references on species compatibility, 1,2,9,21 water quality and environmental control, 1'2'9'21 lighting, 1'3 biological filters, 1'2 sanitation, disinfection and sterilization, 1'21 and nutrition. 19'21'22 A good starting point for a preventative medicine program is quarantine.
Quarantine is designed primarily to prevent the introduction of disease into a water system and to protect the resident fish. Some level of quarantine is essential in any aquarium setting. 21 Incoming fish should be isolated from the established population for a recommended period of time, ranging from 21 days (minimum) to 6 weeks (preferable).l'2 Most owners are unable to adhere to these guidelines be-
cause quarantine systems are temporary and usually labor intensive.1 Isolation is the key to quarantine. The most reliable way to accomplish isolation is by physical separation of the fish, with i n d e p e n d e n t tanks, filters, and pumps. 21 Quarantine tanks should be small for ease of cleaning and fish handling. A flowthrough filter system is ideal but not practical for most clients. A single quarantine tank can be successfully maintained by frequent water changes (every 3 to 5 days) to avoid ammonia and nitrite buildup; however, it is important that the water temperature does not fluctuate by more than a few degrees Fahrenheit to avoid stressing the fish. 1 Other stress reducers in the quarantine tank include providing shelter (polyvinylchoride [PVC] pipe of an appropriate diameter and length works well [Fig 8]) and keeping the fish density to a minimum. 2~ The quarantine aquarium temperature should be actually maintained at the upper end of the species optimum range to speed parasite life cycles. 21 Unless the fish are showing signs of clinical disease, hands-on examination for diagnostic purposes should be delayed until 4 to 7 days after arrival. In the meantime, observation, history taking, fecal examination, and acclimatizing the fish to the new conditions should proceed. 21 Acclimatization involves floating the transport bag in the quarantine water system and slowly siphoning the system water into the bag to effect a complete transition to the new water conditions in 1 to 3 hours. For the next 24 hours, the fish should be kept in a dimly lit, quiet area and not disturbed. 21 In the 4 to 7 days that follow, the fish is watched for signs of disease, such as frayed fins, areas of discoloration or depigmentation, and grossly visible ectoparasitesf I After the fish have had time to acclimatize to their quarantine tank, skin scrapings and gill biopsies to rule out ectoparasites may be performed. The n u m b e r of fish sampled will depend on the total number of fish, their size, and value. Ideally fish should not be allowed out of quarantine until all diagnostic tests undertaken are normal or until the problems identified are already present in the show tank. 21 Any problem identified must be specifically treated and retested to verify efficacy of treatment before the fish is released
Aquarium Fish Dermatologic Diseases
f r o m q u a r a n t i n e . J u s t b e f o r e r e l e a s e , t h e fish s h o u l d b e e x p o s e d to t h e s h o w t a n k w a t e r in o r d e r to a c c l i m a t i z e t h e m to a n y e n d e m i c diseases w h i l e t h e y a r e still easily accessible f o r p o s s i b l e t r e a t m e n t . 21
4. 5. 6.
T h i s f o r m o f p r e v e n t a t i v e m e d i c i n e h a s little a p p l i c a t i o n as y e t in t h e p e t a q u a r i u m setting. T h e r e a r e c u r r e n t l y o n l y t h r e e c o m m e r cially a v a i l a b l e v a c c i n e s f o r fish, a n d t h e s e a r e used exclusively in the food fish industry. Vibriosis, f u r u n c u l o s i s , a n d e n t e r i c - r e d m o u t h d i s e a s e a r e t h e d i s e a s e s f o r w h i c h fish m a y be v a c c i n a t e d . 21 S e v e r a l v a c c i n e s a g a i n s t b a c t e r i a l and viral pathogens are under development a n d s h o u l d b e a v a i l a b l e in t h e n e a r f u t u r e , b u t a g a i n , t h e s e a r e n o t f o r u s e in t h e h o m e a q u a r i a s e t t i n g . 22'23 T h e r e a r e c u r r e n t l y n o p r o p e r l y c o n t r o l l e d s t u d i e s in t h e l i t e r a t u r e o n the efficacy of vaccines for diseases of marine t r o p i c a l fishes. M e t h o d s o f v a c c i n e a p p l i c a t i o n include immersion, intraperitoneal injection, a n d o r a l a d m i n i s t r a t i o n . 21 7. 8. 9. 10. 1 I. 12. 13,
T h e m a i n p u r p o s e o f this r e p o r t was to p r o vide information on the common integument a r y d i s e a s e s o f p e t fishes. M a n y t e x t b o o k s a n d articles on aquarium fishes provide specific t r e a t m e n t r e g i m e n s f o r fish s k i n d i s e a s e s , a n d t h e a u t h o r s e n c o u r a g e p o t e n t i a l p e t fish clinicians to r e f e r to t h o s e p u b l i c a t i o n s f o r a m o r e c o m p l e t e g u i d e to t h e t r e a t m e n t o f fish skin diseases.a,2,5,6,11,24,25 W e h a v e i n c l u d e d a limi t e d t r e a t m e n t t a b l e ( T a b l e 1) o f s o m e o f t h e m o r e c o m m o n l y u s e d m e d i c a t i o n s in f r e s h w a t e r a n d m a r i n e fish s k i n diseases. 5'6'11
1. Stoskopf MK (ed): Fish Medicine. Philadelphia, PA, Saunders, 1993 2. Gratzek JB, Matthews JR (eds): Aquariology, The Science of Fish Health Management. Morris Plains, NJ, Tetra Press, 1992 3. Lewbart GA: Care of Pet Fish. Client Info Series.
Santa Barbara, CA, Veterinary Practice Publishing Company, 1994 Lewbart GA: Basic diagnostic procedures for tropical fish. JSEAM 1:182-187, 1992 Whitaker BR: Common disorders of marine fish. CCE 13:960-967, 1991 Lewbart GA: Medical management of disorders of freshwater tropical fish. CCE 13:969-977, 1991 Stoskopf M: Taking the history. Vet Clin North Am [Small Anim Pract] 18:283-291, 1988 Lewbart GA: Water quality and chemistry for tropical fish. JSEAM 1:79-85, 1991 Lewbart GA: Emergency care for the tropical fish patient. JSEAM 2:38-42, 1991 Pesut AP, Goldschmidt M: Selected integumentary diseases of tropical freshwater fish. CCE 5:343-353, 1983 Lewbart GA: Protozoal diseases of tropical fish. JSEAM 1:121-127, 1992 Selosse PM, Rowland SJ: Use of common salt to treat Ichthyophthiriasis in Australian warmwater fishes. Prog Fish Cult 52:124-127, 1990 Yadav M, Indira G, Ansary A: Cytotoxin elaboration by Ae~vmonas hydrophila isolated from fish with epizootic ulcerative syndrome. J Fish Dis 15:183-189, 1992 Bowser PR, Babish JG: Clinical pharmacology and efficacy of fluoroquinolones in fish. Ann Rev Fish Dis 1:63-66, 1991 Noga EJ: Water mold infections of freshwater fish: Recent advances. Ann Rev Fish Dis 3:291-304, 1993 Anders K, Yoshimizu M: Role of viruses in the induction of skin tumours and tumour-like proliferations of fish. Dis Aquat Org 19:215-232, 1994 Probasco D, Noga EJ, Marcellin D, et al: Dermal fibrosarcoma in a goldfish: Case report. JSEAM 2: 173175, 1994 Huerkamp MJ, Ringler DH, Chrisp CE: Vitamin E deficiency in goldfish fed a shellfish derived diet. Lab Anim Sci 38:178-181, 1988 Blazer VS: Nutrition and disease resistance in fish. Ann Rev Fish Dis 2:309-323, 1992 Varner PW, Lewis DH: Characterization of a virus associated with head and lateral line erosion syndrome in marine angelfish. JAAH 3:198-205, 1991 Lewbart GA, Harms CA: Preventative medicine for pet fishes. JSEAM 2:128-132, 1993 Newman SG: Bacterial vaccir~esfor fish. Ann Rev Fish Dis 3:145-185, 1993 Leong JC, Fryer JL: Viral vaccines for aquaculture. Ann Rev Fish Dis 3: 225-240, 1993 Scbmahl G, Taraschewski H, Mehlhorn H: Chemotherapy of fish parasites. Parasitol Res 75:503-511, 1989 Ingebrigtsen K: Factors affecting drug disposition in fish. Acta Vet Scand Suppl 87:44-56, 1991
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