AQUARIUM & POND ANSWERS;
Freshwater, Marine, Sick Fish, Lighting, Baths

 

By Carl Strohmeyer-PAMR 40+ years experience

Updated 5-9-23

The purpose of this article is not to provide any specific treatment regimen for the readers fish, rather to provide an outline that will provide a better chance for success over the typical "my fish are sick and what medications & how much should I dump into my aquarium" question.
Obviously the starting place is aquarium disease prevention, but many readers will be too late to this aspect of fish husbandry, which is the point of this particular article.

A good professionally written article for prevention of aquarium disease is this one:
"Aquarium Disease Prevention; Proven Steps for a Healthy Aquarium"

Every single step in the above article should be followed to a T and I can guarantee that the incidence of disease will go down greatly.

Hopefully readers will acquaint themselves with this above referenced article which will in part form a basis for this article as I go forward.
As well this article is another good read before one goes forward with any fish treatment:
"Aquarium Medications; Part 1"

I cannot emphasize more that many if not most fish diseases, especially bacterial or fungal in nature (including secondary infections to parasitic infestations) have a background issue. Failure to eliminate this background issue(s) will often result in failure of treatment.
Often the "background issue" is more than half the problem, so a good part of the treatment plan is REMOVING this background issue!!
A good analogy I like to use as to why it is so important to eliminate these issues is this:
"Not correcting causes or background issues is akin to standing in a burning building asking for a treatment for burns, while not leaving the burning building"

Unfortunately in my dealing with questions of what one should treat for a given set of symptoms, I have found that for the majority of these questions, the person asking the question either only addresses underlying issues in part or not at all.
Often this is not because the person does not want to, but they simply do not have the means or the availability for whatever reason to do so.
I would also point out, and while this may seem a bit harsh, it is still the reality, and that is this is still not a valid excuse to continue to ask for alternative treatments or complain to persons such as myself that the treatment failed when proper procedures have not been completely followed.

I personally spend a copious amount of time writing articles, answering questions, or even paying staff to help for free, but please remember that one needs to obviously follow the medication course prescribed, but just as importantly if not more so, deal with ALL underlying causes to a given fish illness problem. So repeatedly going in circles when not following exactly advice given is in my opinion disrespectful to the person who is trying to help you with your fish illness issue.

When you are asking others for help, whether it be online or at your local fish store, make sure you ALWAYS provide background first; including ALL water parameters (mineral Cations too), filtration, maintenance, feeding, & fish kept. Past fish treatment history is important too.
I cannot tell readers how many times people have asked for my help and told me that their water parameters were OK/good, but when pressed to provide actual COMPLETE numbers or I went out personally and checked, the water parameters were anything but OK/good. Often the important KH & GH tests were missed too, partly due many well meaning aquarium keepers fooled into thinking that their "API Master Test Kit" was all they need (a symptom of shopping discounters or getting information from "cut & paste" internet articles, videos or forums).

As an analogy; your personal Doctor always has your history, takes your vital statistics, etc., so why should we expect those we are asking to help us with our sick fish to guess, especially when one considers we often are asking others to help us sight unseen and with far less tools at our disposal than a Doctor would have?

Here first are basic procedures to check off before treating any fish sickness issue:

• Make sure ALL water parameters are as they should be. This includes well known and obvious parameters as well as less obvious parameters. This is part of the "background issues I mentioned earlier.
  It is also important to know the parameters of any new water used for water changes, so as to make note of any changes that might happen in the aquarium after the water is changed (in other words a baseline). As well, sometimes sudden changes in pH can cause illness in fish, so knowing the pH of new water for water changes versus old water is important.
  
  INCLUDING:
  • Ammonia; under .5 ppm (best 0 or less in most circumstances)
    Exposure to high ammonia in the past can be a set up for opportunistic infections in the future due to gill & organ damage (Methylene Blue baths can sometimes help with gill damage, but more so if done immediately).
  
  
  • Ph; stable within the generally accepted target range of the fish to be kept (if the target range is 6.5 to 7.5, stable at any number there-in)
  
  
  • KH; this too can vary depending upon fish kept, but generally anywhere from 50 ppm to 150 ppm
    KH (carbonate hardness) can keep an aquarium from pH crashes and knowing your KH on a regular basis can also tell you if it drops rapidly even after adding buffers that your bio load is too high and/or water changes are not adequate. A low or unstable KH can be an indicator or background issue for fungal/Saprolegnia and Aeromonas bacterial issues.
    Further Reading:
    Aquarium Chemistry; KH (Carbonate Hardness)
  
  
  • Flow and oxygen levels; most persons do not have an oxygen test kit, so having a water flow turnover rate of 5 times for an average non-planted freshwater aquarium usually will indicate adequate oxygen levels
  
  
  • Bio Load & Decomposition & DOC; a high bio load, often compounded by decomposition of organic and high dissolved organic compounds will often be a breeding ground got Aeromonas and Saprolegnia. Fixing this is as important as any treatment regimen.
    High Nitrates (over 40-50 ppm) can also be a symptom of this issue too.
    Further Reading;
    *Bio Load in Aquarium or Pond
    *Aquarium Nitrates
  
  
  • Redox and Mineral Cations; this is an aspect of fish care that continued research both in and out of the hobby/industry is proving to be key.
    In diseases such as Columnaris, having a less than optimum Redox whether it be the electromagnetism of the water, missing mineral Cations, low water rH, low or non existent GH, or simply too many free radicals (oxidizers) making for an unbalanced Redox; this is a major aspect in whether you will be successful in treating or just as importantly not have this disease present in the first place (since it is an opportunistic infection).
    
    Other diseases such as HLLE have a direct relation to Redox (or a Redox quality/balance measurement called Relative Hydrogen aka rH). In freshwater, rH should be 23 to 26, otherwise your aquarium may not be as conducive to good health as it could be.
    
    As well GH is a measurement many forget the importance as it has a direct relation to osmoregulation, mineral Cations, Redox & more. For most FW aquariums your GH should be at least 150 ppm, but much higher is still OK and with some fish such as livebearers, puffers, Lake Malawi Cichlids and more; a higher GH is called for.
    
    Further Reading; Aquarium Redox
  
  
  • Temperature & Temperature History; sudden or even gradual but pronounced swings in temperature can have a major impact on a fish, often with permanent internal organ damage that can lead to opportunistic infections that may not be curable due to slow organ failure.
    An example would be a fish such as a Betta exposed to 90F plus temperatures, this can result in permanent organ damage such as to the kidneys.
  
  
• Follow ALL professional based treatment regimens when you treat for a disease.
  This includes full dose of medications for the recommended days, any baths, swabs or similar if required, increased or decreased water temperatures if required, and use of sodium chloride salt if required (as an example, the last two are required for Columnaris treatment).
  This also includes synergistic combinations such as Kanamycin WITH Nitrofurazone for Columnaris and other infections. Using just one or the other as per many professional recommendations is a recipe for failure.
  
  In other words, if a fish bath, dip, or bare isolation/hospital tank is called for in the treatment regimen, this should be used, otherwise do not expect optimum results.
  
  A common medication mistake is using "first aid" treatments such as Melafix for full blown infections, this is analogous to using Neosporin for a staff infection in a human. Then some will make very uninformed statements that "Melafix killed their fish".
  Reference: Melafix Dangers; Betta, Labyrinth Fish, Pencil Fish
  
  Another common mistake is using medications that likely not effective for the issue at hand. A common medication here is Metronidazole.
  This is an excellent medication when used for what it is called for, but for some reason of late it is commonly used (sometimes in combination products such as General Cure) for fish diseases that are likely deterioration most likely caused by common aerobic gram negative bacteria commonly found in the aquarium and/or "bio filter". Problem is, Metronidazole is most effective with anaerobic gram positive & some anaerobic gram negative bacteria.
  
  Further Reading:
  Aquarium Answers article about Fish Baths


• Follow ALL recommended fish husbandry aspects of fish care, including water changes, good filtration (including true germicidal filtration), proper mineralization, feeding, even optimal tank size, tank mates and places to hide from aggressive tank mates (example would be a small Mbuna/African Cichlid aquarium with little rock structures for weaker/submissive fish to escape, which can result in stressor that allow a disease such as Columnaris to get a foothold and then even spread to stronger fish in this aquarium).
  
  I have addressed this in part in the overview section of this article, but since optimal aquarium conditions are one of the key aspects of most ALL fish disease treatments, I will note this again and expand a little more on it.
  
  A common line I hear from well meaning aquarium keepers or even well meaning persons giving advice is: "Yes, my water conditions are good, I feed a good fish food, & I used what you stated".
  Then I dig deeper and I find out that only part of a treatment is followed, they did not maintain a stable KH, proper mineralization and Redox, and what they assumed was a good fish food is what the person at PetsMart told them was best or they purchased from a large online marketer such as Amazon.
  Even if a person has a UV Sterilizer, it often turns out to be just a Clarifier such as a "Green Killing Machine" or the many HOB UV filters they purchased on Amazon that might be great for green water, but does little to address disease prevention.
  
  I cannot emphasize more the reading of these articles:
  *"Aquarium Disease Prevention; Proven Steps for a Healthy Aquarium"
  *"Aquarium Redox Balance"
  *"Aquarium UV Sterilization; Facts & Information"
  *"Fish Nutrition"


• Consider an online fish care forum that is based on honest researched information, healthy interaction/discussion; and with members that are NOT about popularity and insulting others while lacking true/honest moderation. As well many forums have members and Admins that rarely read experience/researched information that is simply passed around like the telephone game often resulting in inaccurate information being given.
  A forum that thinks Amazon is the answer to all your aquarium needs is one to be avoided, especially since many of the best treatments cannot be found here (along with many of the best aquarium products such as UV Sterilizers). It is also noteworthy, that by shopping Amazon, this only hurts professional sellers that support true information websites such as this one.
  
  Here are our suggestions for sick fish care & prevention (the first two are the best places to reach aquarium fish keeping guru Carl Strohmeyer):
  • The ORIGINAL Everything Aquatic Forum Board
  • Everything Aquatic Forum; MeWe Edition
  • Everything Aquatic Forum; Facebook Edition
  • Facebook Group; FRESHWATER FISHUES·Sick Fish Place

HERE IS AN EXCELLENT VIDEO ABOUT THE BEST AVAILABLE TREATMENTS:

AAP Professional Aquarium & Pond Medications

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Next, here are causes for failure of any fish illness treatment regimen:

• My first thought here is to point out that even a Medical Doctor with her/his years of college and later internship and experience along with the medical equipment and test at her/his disposal cannot cure everything, but not addressing underlying issues only complicates any human medical treatment further.
  An analogy here is a patient who asks the doctor why he/she had a heart attack at only 42 years old, but fails to recognize the doctors advice that he/she is obese and needs to stop eating a Big Mac burger for breakfast, lunch, & dinner.
  
  Unfortunately, many aquarium keepers will always start with medications or be advised as such (which of course medications are important), however your starting point should ALWAYS be water parameters & diet that provide optimum fish osmoregulation, as little oxidative stress, and as clean as possible water (not over cleaning whereby you wipe your bio filter either).
  Quoting from a Doctor who works with refugees whom I just listened to a talk from; He noted many are trained to administer Metronidazole to refugees suffering from malnutrition, and severe dehydration resulting in life threatening diarrhea. He stated world health practices has found this to be totally wrong!
  He noted that first get fluids and osmotic balance/electrolytes, and most often the patient will recover without Metronidazole and only administer Metronidazole after recovering the patient from the diarrhea.
  DITTO YOUR FISH!
  
  The other aspect of this bullet point is even is you were to follow everything correctly, have all the resources possible, and remove underlying causes; success is NEVER guaranteed.


• Failure to follow medication treatment regimen or substitutions for what ever reason.
  
  This is very common cause of failure.
  Examples of failure to follow instruction include using just Kanamycin when the synergistic blend of Kanamycin and Nitrofurazone are called for to treat infections such as Columnaris. OR often even when blended, often aquarium keepers will utilize the less effective Furan 2 which calls for a different treatment schedule, when a better blend with AAP's Yellow Powder/Premium Nitrofurazone is the better choice (AAP Yellow Powder/Premium Nitrofurazone generally only requires the one initial treatment with Kanamycin followed by 2-3 more Kanamyacin/Kanaplex treatments).
  Either one or the other will generally result in failure!
  Or another example is if a Medicated Wonder shell is needed in addition to the above noted combination example to lower oxidative stress for a serious multi-pathogen or unknown issue, the chance of success on a likely difficult situation will be lower.
  
  Reference: "Aquarium Medications; Part 1"
  
  Product Resources:
  * AAP Yellow Powder/Premium Nitrofurazone
  * AAP/SeaChem Kanaplex (Please support this article and the professional aquarium keeping industry/hobby by purchasing here rather than discounters such as eBay and Amazon)
  * AAP Premium Wonder Shells; (the ONLY Authorized full-line online retailer with the freshest product, unlike clearance product sold elsewhere including Amazon. Like a battery, Wonder Shells loose their Cation charge over time, so purchasing cheap/clearance product is not wise)


• Similar to the above is taking advice from multiple sources/people.
  The problem with trying to blend multiple different advice methods into one treatment is these are often conflicting and could result in over medication. This is NOT to say there is only one way to treat a specific problem, but I can state from decades of experience and client sick fish calls that combining treatment methods often results in failure!!


• Genetics & poor breeding.
  This is more common than many know, especially with fish such as Betta and goldfish which are heavily inbred for certain attributes with fish physiology be damned, thus resulting in very genetically weak fish (think about how many pedigree dogs are also over bred).


• Poor care such as over crowding with resulting high ammonia exposure at some time in the life of the fish resulting in permanent organ damage that makes a fish susceptible to disease and treatment difficult later in life.
  This is common with carnival goldfish, but again common with Bettas in how they are shipped and kept right up to their purchase.
  
  As noted in the first section, as to following ALL optimal husbandry practices, when this is not done this can make a treatment less effective or not effective at all.
  Often the result is that a more mild treatment regimen that WOULD WORK IN OPTIMAL CONDITIONS will not work, while a strong, sometimes harsh treatment, still will work. Then anecdotal observations that treatment A does not work while treatment B does, when in reality using more scientific method, we find this observation is not true by virtue that that treatment A was not given a fair chance to succeed via better fish husbandry standards.
  I have seen this incorrect observation in social media as per ParaGuard versus Quick Cure for Ich treatment or General Cure versus Levamisol for worm treatments (the first in each example representing the more mild treatment).





• Poor Diet.
  This also does not need to be a current poor diet, it can be a past poor diet and in fact generally is since diet issues rarely show up immediately.
  Diet issues include renal (Kidney) failure due to incorrect or poorly optimized protein levels, too low fiber, and fatty liver disease from too high of energy levels again instead of optimum levels (optimum is 280 energy points).
  These are unfortunately quite common as even most of the best of fish food diets that use top notch ingredients do NOT optimize! This is even a bigger problem with most common fish foods fed.
  A few examples as per exceeding optimum energy levels are: New Life Spectrum at 329, Cobalt Fish Foods at 420, and Wardleys' at a whopping 501 energy points!

  A seemingly contradictory point is that while long term fish health is provided by fish foods with low energy levels and higher fiber content, fish foods that are pre-digested and higher in energy levels is often best while treating sick fish. A good example here would be AAP/Gamma NutraShots which can be thought of as a frozen food that does not need to be frozen and stimulates natural feeding behavior.

  Unfortunately once the fish is sick due to past poor diets, even improved diets often cannot correct the issue, thus resulting in failure of treatment. This is especially true for Dropsy and other causes of bloating and even for Columnaris.
  
  
  Reference: Fish Nutrition
  
  Recommended Fish Foods:
  *AAP Custom Premium Optimized Fish Food
  *AAP Spirulina 20
  *AAP/Gamma NutraShots

Other Recommended Reference & Product Sites

AAP Hydro Sponge Filters

THE PREMIUM Aquarium Sponge Filter with as much as 5 TIMES the bio and mechanical capacity of commonly sold Chinese knock offs!!
Definitely worth the extra $1-3

UV Replacement Lamps/Bulbs; Aquarium or Pond
For TRUE High Output, Hot Cathode, Low Pressure UVC Germicidal Bulbs, for aquarium or pond

PUR or RQE, YouTube Video Fail- Guide to lighting a planted tank

AquaRay Ultra Premium Aquarium LED Lights
Highest in PUR, The ONLY LED with an IP67 rating or higher for water proofing along with a full 5 year warranty to back them up!
Why purchase brands without this rating such as the Finnex, Current, or Fluval only to be essentially placing an electronic light emitting device over your humid aquarium with little or no guarantee? In the long term, you WILL PAT MORE!

TMC V2 RO Filter systems; the very best you can buy with TDS meter (far superior to 4 stage RO/DI systems sold via Bulk Reef Supply, Amazon, or eBay that use the inferior cellulose triacetate membrane made by Dow):
Reverse Osmosis Aquarium Water Filters; with TDS Meter

Labels: aquarium fish diseases, fish sickness, fish tank diseases, my fish is sick, sick fish, treating sick fish, what am I doing wrong

 

By Carl Strohmeyer-PAMR 40+ years experience
Updated 9-25-19

Fish Tuberculosis is generally caused by Mycobacterium marinum, a bacterium closely related to the human TB (Tuberculosis) bacteria, Mycobacterium tuberculosis, although incidents of Mycobacterium triplex have also been reported with Bettas.

Despite some internet claims, based on my many years of "house calls" and other professional aquarium maintenance work has shown Fish "TB" to be relatively uncommon with the exception of cases where the bacteria has been passed around and the fish' immune system has been compromised, this is especially the case with recently confirmed Mycobacterium triplex.
This seems to be more common among breeding and showing circles/clubs where water equipment cross contamination is common.
The above said, be careful about assuming your fish have Fish TB, unless all symptoms are present and treatment for more likely infections have failed.

However Bettas and Gouramis for reasons not 100% known seem to be more susceptible or have been placed in conditions where tuberculosis is more likely to overcome the fish' immune response.
Please read the "PREVENTION" section for more about TB in Bettas in particular

Treatment for Mycobacterium tuberculosis is often long and not always successful, as well low fish immunity due to poor aquarium parameters (including Redox Balance), along with fish age or even simple stress from tank mates can add to treatment difficulties or make treatment impossible (especially since Fish TB is difficult to treat anyway)

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A myth I have seen written in a few "circles" (for some reason I have found this myth especially common on certain Betta Forums), is that Fish TB can also cause full blown human TB which is simply not true (only mild localized infections in healthy adults humans).
However it is still best to avoid fish to human transmission, especially if your immune system is compromised in any way.
Generally when the Mycobacterium marinum bacteria infects humans it is a dermatological issue as the bacterium usually enter the skin via small abrasions or cuts when you are performing aquarium maintenance.
The symptoms in humans are usually restricted to skin and soft tissue destruction in most instances of Mycobacterium marinum infection via small purple lesions that can gradually grow. It is noteworthy that in my decades of professional aquarium maintenance with literally 1000s of aquariums, I have only noted a couple of proven fish to human TB transmissions, so be careful of alarmist web sites.

Another myth about Fish TB, especially since it seems to have become the aquarium fish disease "De Jour" (disease of the day), is its transmission.
Based on emails, phone calls and discussions with my maintenance friends, you would think every fish that is sick now suddenly has this disease.
While it certainly seems to be more common and virulent as per confirmed cases, it is NOT commonly present in an aquarium (unlike Aeromonas, Columnaris, or Pseudomonas bacterium).

So in the case of fish that have been living in an aquarium for months and often years without any outside exposure to other fish, the facts are it is impossible for the fish to suddenly come down with a Mycobacterium infection!
Usually this false diagnosis with no history of possible exposure is simply the result of a simply weak or old fish showing symptoms that are often common to Fish Mycobacterium (TB).
What is also very noteworthy with a fish that may be showing symptoms common to Mycobacterium, if the fish dies within days of the first symptoms, it is VERY LIKELY that your fish did NOT have Mycobacterium as generally Mycobacterium kills slowly!!

Even with potential exposure, in my experience with confirmed cases of Mycobacterium, transmission usually ONLY happens in aquariums with old, genetically weak, injured, or with poor tank water parameters (which includes a poor aquarium Redox Balance).
In other words, under normal conditions this is not a highly contagious fish disease!

Then as per poor water conditions, genetically weak, poorly fed, etc. fish, it is more likely the fish have another bacterial infection and correcting these conditions is job one. Most common with Bettas in particular is lack of mineral Cations resulting in poor osmoregulation and increased oxidative stress (poor Redox balance)

Identification:

If staining for identification, Mycobacteria stain bright pink against a blue background (as these bacterium are acid fast).

However, most aquarium fish keepers do not have the ability to grow cultures or make slides; so the symptoms of Fish TB are usually wasting away, lesions on the fish' body, loss of scales and/or coloration, and especially skeletal deformities such as curved spines.

The Betta fish in the picture above (please click to enlarge) displays classic symptoms of Fish TB in finage, skeletal deformity, and wasting to the point light can slightly penetrate her abdomen as seen in the light spot.
From Testing for "Fish TB"; AquariaCentral

The fish to the right is a largemouth bass showing clinical signs consistent with mycobacteriosis; note the ragged fins, sores, and general deterioration of the fish, differing from more common fish diseases such as Aeromonas and Columanaris.

Mycobacterium triplex can only be identified by 16S rDNA sequencing, so positive identification is difficult.

Treatment:

As with ANY fish disease, always start with getting your aquarium water parameters in order (as well as feeding), which in most my client house/office calls over the years with TB or copycat fish diseases this was a major issue.
Reference this article for more in depth help here:
A Healthy Aquarium, Fish Disease Prevention

Mycobacterium marinum
Time of Treatment is VERY long and is generally administered for at least three months. Cure rate is well under 50%, but also do not believe those who state it cannot be cured as I have many times.
A hospital tank treatment is advised for fish TB since this generally is a very long treatment regimen and a three month treatment of ANY antibiotic can result in serious damage to your aquarium bio filter.

The three most proven antibiotic methods, which can and should be used in a combination of two of these drugs along with the other described alternative treatments:
*Kanamycin (Kanaplex)
*Neomycin
*Isoniazid (from Aquarium Medications Part 2)

Sometimes a Sulfamethazine/Trimethoprim Combination can be effective too.
Resource:
*Sulfamethazine/Trimethoprim Combination (sometimes effective)

Often a "cocktail" of these medications along with a fish bath (mentioned next) is needed for any hope of success, which can be very harsh on the aquarium environment. So unless the infection is systemic, a hospital tank might be best (adding a TRUE level one capable UV Sterilizer to your main tank is suggested to check spread, see later in the prevention section of this article.

A fifth consideration, albeit less field tested (it does show lab results though) is Usnea, which from my experience should only be administered in a "Fish Bath" form for 30 minutes. Methylene Blue should also be used in this bath, but no other antibiotics should be used in this bath with Usena.
These baths can be rotated; meaning one bath with Usena and Methylene Blue and the next bath with MB along with one or two of the other antibiotics, then back to the Usnea

Usnea is best as a used as a bath ALONG with an in tank treatment with one of the first three noted medications (or better hospital tank).
Further Information: Organic Fish Treatments; Usnea

A sixth consideration is Allicin, the active ingredient in RAW Garlic. Mycobacterium marinum) has been demonstrated to be effectively treated with Allicin, at least in vitro.
SeaChem Garlic Guard can be used in a fish food slurry preparation and mixed with both Neomycin and Kanamycin for improving the potential effectiveness of tuberculosis treatment.
See: Fish Nutrition; Garlic

Recommended Product Resource:
Garlic Guard; for Fish TB, Appetite Enhancer

A final consideration that might be helpful, in particular if the diagnosis is INCORRECT (which is common), is the use of Medicated Wonder Shells. These address many aspects of fish health, including problems that are simply symptoms of fish old age and not any disease in particular.
While a Medicated Wonder Shell is not a strong treatment for any particular disease, these are helpful as both follow up treatments and mild treatments that also address essential water parameters that might be out of balance (such as Redox).

Recommended Product Resource:
Medicated Wonder Shells

Back to Fish Baths; regardless of the medication or combination of medications used in tank, I suggest a Fish Bath with one of the first four before mentioned treatments (not garlic) at least once per day during this time period.
In fact in some cases the fish baths were all that was needed for success assuming these were carried out regularly.

Now for the bad news, from experience and others, once the fish became emaciated I had little to no success saving them.

Please Read/Reverence these Articles:
*Aquarium Medications; How Medications Work, and Which Ones to Use and Not to Use
*Fish Baths, How to Perform

Treatment of Mycobacterium triplex (not M. marinum) in human studies has shown it to be nearly impossible with only reduction of symptoms, not eradication of the bacterium.
These treatments used levofloxacin, ethambutol, and clarithromycin; all of which NOT available in fish medications.
You best bet with this rare strain (assuming your fish even has it), is to sadly euthanize and sterilize EVERYTHING, then start over.

How NOT to Treat:

The use of salt either in baths or in the aquarium will have absolutely no affect on Mycobacterium tuberculosis since this bacterium thrives equally well in salt or freshwater.
Temperature increases or decreases have little effect and in fact a temperature increase over 30°C. (as with Columnaris) often worsens a Mycobacterium tuberculosis infection.
Temperature decreases has shown some anecdotal slowing of the progression of Mycobacterium tuberculosis, but no cure.

Prevention:

There is not a 100% proven way to prevent Aquarium Fish Tuberculosis (as with most pathogens), however based on my own observations going back to 1977 (working at a Pet Store Fish department and then my aquarium maintenance company), I definitely noticed patterns.
Emails from customers and questions I see asked in forums and elsewhere have added to this same pattern.

Here are a few known factors:

• High organic loads, water quality characteristics common in intensive systems, and very crowded populations can all exacerbate the infection.


• Feeding feeder fish, fish remains, fresh worms and similar. Better if fish TB has been a problem a truly top notch prepared fish food such as Clay Neighbor's AAP Custom.


• One pattern is what I noted earlier and that is Bettas and Gouramis have a higher incidence of both suspected and proven cases of Mycobacterium marinum Tuberculosis infections.
  I also noted that certain vendors (wholesale suppliers) would have a higher incidence of TB infected fish, so avoiding the purchase of fish from places that you have suspected TB on numerous occasions may also be helpful; this said, do NOT write off a retailer or vendor based on 1 or 2 suspicions of Fish TB, as it may have been another disease pathogen, as well frankly no vendor/retailer is perfect!.
  
  Also be careful with Betta shows or similar, as I believe that this is both a major stressor AND infection point.


• As for procedure you can do to prevent Fish TB infections; there are many.
  The most obvious is as stress free an aquatic environment as possible since stress due to many factors seems to be a major factor based on my work and research.
  This includes stress from water conditions and tank mates.
  Changing water regularly, maintaining a stable pH & KH, near 0 ammonia (NH3) and nitrites, a balanced Redox and ESSENTIAL aquarium positive mineral ions.

Further References:
*Aquarium Cleaning
*Aquarium Chemistry; In Depth, from Beginner to Advanced
*Aquarium Redox for Fish Immunity, Health

The use of Aquarium UV Sterilization with a correctly applied UV Sterilizer performing at Level 1 Sterilization (this will NOT and CANNOT be achieved with the many low end UV Clarifiers such as the Green Killing Machine, AquaTop Hang On and similar water clarification ONLY devices flooding the market!).
The correct use of a UV Sterilizer can aid in Redox Balance and in the end also aid in fish immunity and is a MUST for an aquarium with a history of Fish TB to check the spread based on my extensive experience with Fish TB and true UV Sterilizer use.

MUST READ Reference:
Ultraviolet Sterilization, Facts & Information; Including Level 1 & 2

Recommended Product Sources:
Level 1 & 2 UV Sterilizers
Clay Neighbor's AAP Custom Super Premium Fish Food; Far Ahead of any other!

The use of SeaChem Garlic Guard or similar in fish food can also be used in an ongoing basis to improve fish health and prevent Fish Tuberculosis.

Back to Bettas in particular, a problem I have seen based on patterns that are almost 100% identical and that is many Betta Forums and Clubs will pass around the same methods of Betta keeping that can increase the likelihood of TB infections.

This includes constant chasing of pH, 100% water changes, keeping of Bettas in very small closed environments, lack of positive mineral ions essential to immune response, passing around fish (with constant exposure and stress), and limited gene pools due to interbreeding.

My suggestion is to keep your Betta in a system with a larger volume of water with small individual containers.

Within this system these practices can aid in TB prevention:

• Good bio filtration with quality sponge filters, or even better Fluidized Sand Bed filters, use of products such as SeaChem Purigen to further "clean" the water.
  
  Product Resources:
  *AAP High Capacity Hydro Sponge Filters
  *AAP Premium Fluidized Sand Bed Bio Filters
  *SeaChem Purigen; Clears Water of Dangerous Toxins


• Maintenance of a stable pH & KH with as little of an effort as possible using products such as Alkaline Buffer, Acid Buffer, Driftwood, Pillow/Frog Moss, blended RO Water; IF NEEDED!
  
  Product Resources:
  *SeaChem Alkaline Buffer
  *Zoomed Frog (Pillow Moss) for Natural Water Softening


• Constant drip of ESSENTIAL mineral ion replenishing products such as SeaChem Replenish, or BETTER and more simply with AAP Original Wonder Shells This is one of the major causes of symptoms of Fish TB as the lack there of results in poor osmoregulation and higher oxidative stress.
  As well to not be overly concerned with GH.
  Further Reference: Aquarium Chemistry, GH
  
  Product Resource: AAP Wonder Shells, Mineral Supplement, Unique Version


• Do NOT pass your fish around in environments out of your control and attempt to bring new fish into your breeding operations from sources you are not 100% sure of.


• Utilize a GOOD Level 1 UV Sterilizer such as the TMC Vecton. Do not fool yourself into complacency with one of the many UV Sterilizers sold for under $50 via Amazon or similar discounters, as there is not a one that can perform level one Sterilization (most do not have HO UV lamps and are missing pre-filters that are required)!!.
  
  Reference:
  UV Sterilization; Water Flow for Level 1
  Buying Aquarium Products via Amazon (& Chewy, eBay)
  
  Product Resource: TMC Vecton Premium High Dwell Time Aquarium, Ultra Violet Sterilizer
  
  If you are breeding Bettas, keeping the Bettas within isolation boxes/containers with a much larger 'cubical based centralized system' is a practical way to utilize a good UV Sterilizer, as well as maintain much better water quality.
  The picture below displays aquarium cubicals that I highly suggest for anyone serious about breeding bettas so as to be able to maintain more stable water quality and also utilize UV Sterilization!
  
  
  
  These cubicals can be placed in larger aquarium and can also be blacked out to prevent interaction between Bettas.
  However the cubicals do allow for interaction of "smell". My suggestion for this is to keep certain Bettas at different points in their breeding cycle together in the same aquarium system (in other words multiple systems

See also the articles below in the references/resources dealing with Aquarium Disease Prevention for more help in Fish TB prevention

Further References/Resources:

*Mycobacterial Infections of Fish
*http://www.aquariacentral.com/forums/showthread.php?220754-Testing-for-quot-fish-TB-quot-pics-included
*Fish Diseases; Univ. of Florida
*Aquarium Disease Prevention; Proven Steps
*Mycobacterium triplex Pulmonary Disease in Immunocompetent Host

By Carl Strohmeyer
Copyright 2019

Other Suggested Resources, Products

*
AQUARIUM AND POND INFORMATION;
Well researched and up to date aquarium and pond answers, help, and links

*Columnaris in Aquarium Fish (also Fungus)
This is easily the most in depth and regularly updated on the subject of Columnaris and Fish Fungus to be found ANYWHERE on the Internet!

*The Aquarium Nitrogen Cycle
The most up to date article on the subject of the Aquarium Nitrogen Cycle, based on both research and 35+ years of professional experience with 1000s of client aquariums!

*
UV Sterilization
This article covers many aspects of Aquarium & Pond UV Sterilization from how, why, facts, myths, and maintenance including the importance of changing UV Bulbs regularly.

*

UV Bulbs; Page 1
As noted above, changing these PREMIUM bulbs/lamps every 6-12 months is essential for a properly functioning UV Sterilizer

*Aquarium Silicone Sealant; USDA 100% Fish Safe
100% Fish Safe, USDA & Agricultre Canada approved, the same CANNOT be said for Hardware Store brands!
Excellent for building aquarium systems of multi-tier fish housing.

*
Aquarium Lighting; Basic, Reef, Planted
The above referenced article is easily the most in depth and regularly updated on the subject of Aquarium Lighting to be found ANYWHERE on the Internet!

Atison's Spa Clear; Indian Almond Leaf Conditioner
Clear Betta Spa contains wild almond leaf extract to simulate the natural environment of the native soft water fish.
Other natural botanicals, including Yucca extract, help control ammonia, reduce stress and maintain cleaner water.

FISH AS PETS
Fish as Pets with articles & commentary of Interest to the Aquarium Hobby

*Planaria & Detritus Worms in Aquarium; Which is Correct?

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Labels: Aquarium Fish TB, Betta, Betta Tuberculosis, emaciated fish, Fish TB, Fish Tuberculois, Mycobacterium marinum, Mycobacterium triplex, sick fish

 

Fish Baths/Dips for supplemental (& even primary) treatment of Bacterial infections, wounds, sores, Fungus (Saprolegnia), parasite infestations & more

By Carl Strohmeyer-PAMR 40+ years experience

Sections:
Basic Ingredients What is a Bath or Dip used For What is Better; A Bath or Dip Performing a Fish Bath Important Bath Tips Bath Risks Medications in Baths Alternatives to Methylene Blue	Potassium Permanganate Cautions Dips, Swabs, etc. Coral, Anemone Dip Helpful Conversions (metric to SAE, etc.) Bath Video Feedback Article/e-book Download

Updated 11/26/24

Although the Article; "Aquarium Disease Prevention" has a relatively in depth explanation of how to perform (& why) a fish bath or dip, this Aquarium Answers post/article will hopefully expand more on this subject for a better understanding. I am also including input from members of Everything Aquatic Forum to further assist in this article.

References:
*Principles of Aquarium disease Prevention and Treatment
*Everything Aquatic; Aquarium Forum Board
*Everything Aquatic; Performing a Medicated Fish Bath

The use of Swabs and Dips is also discussed in this article.

Why a Fish Bath (both positives and negatives)?

• Provides an environment to use products that might otherwise harm your display aquarium, in particular the nitrogen cycle.
  While Methylene Blue can be used in the main aquarium, it is generally more effective in concentrations best served in a bath without the risk to the bio filter.


• Allow for stronger short term exposure to medications, which can be important for some more delicate fish


• Allow for use of osmoregulators such as sodium chlorides or magnesium sulfate (Epsom Salt) in dosages that may not necessarily be therapeutic but definitely allow for the pulling of fluids through the body of the fish which can help with cleansing of toxins and help with treatment of Swim Bladder issues, Dropsy, or similar.
  These concentrations that are more effective of sodium chloride/magnesium sulfate generally are not safe for use in the main aquarium for long term exposure.
  
  As for magnesium sulfate (Epsom salt), while I have not specifically know the mechanism, what I do know from experimenting around is that it works well in a bath, but is actually detrimental “in-tank” for freshwater.
  My guess is magnesium is more of a controlling osmoregulator like sodium chloride can be as well, not something the fish need much of.
  As an analogy, think of how our atmosphere is mostly nitrogen, yet it is oxygen that we utilize. Ditto magnesium sulfate in water, especially marine aquariums, but over loading in freshwater long term seems to have a negative affect, while a short term bath of magnesium sulfate seems to help draw fluids though the fish in a therapeutic way


• For genetically weak or old fish, a bath can provide for a treatment while not affecting the main aquarium environment, which most medications used in tank have a negative affect on the aquarium environment.
  As well the fish bath often makes a good compliment to in tank treatments, especially when using a more mild treatment such as AAP/API Pimafix.


• A negative for a fish bath, especially for large fish is the potential stress & injury of netting and moving a fish back & forth.
  For me this was not too much of a problem, but if you are nervous, this can become more of an issue.
  
  A way to mitigate this is by having a small breeder box as later discussed in this article.
  Another way for larger fish is to house your large fish in a separate large hospital tank that becomes their bath for 30 minutes once or twice per day, then is flushed with water from the display tank after the bath, while the display tank gets fresh water.

The basic ingredients of a bath include:

• Salt (Sodium Chloride)
  Further Reference: Salt Use in Freshwater Aquariums
• Methylene Blue (standard 2.303% solution or premium AAP MethyBlu 5% solution).
Methylene Blue can be substituted with Potassium Permanganate (standard 3.84% solution) in certain instances
• Epson Salts (Magnesium sulfate) in small amounts can be used as well for added aid in internal issues
• Further medications can be added (this will be addressed later in this article)

What is a Bath or Dip used for in the Treatment of Fish Diseases or Similar?

• Treatment of sores or injuries, especially open sores that expose deeper tissues (often minor injuries do not require a bath/dip).
  The Methylene Blue will stain tissues and aid in prevention of bacterial growth (it is normal to stain areas of the fish that has lost their natural slime coat), as well Methylene Blue will increase available oxygen to tissues. Swabbing (or dripping) the wound, sore, or red streaks (caused by Septicemia) with Methylene Blue prior to a bath often increases the effectiveness.
  
  Recommended Product Sources:
  *AAP MethyBlu Premium Concentrated Methylene Blue (recommended)
  *Standard Methylene Blue from AAP


• As an Aid to Ich, Velvet and similar parasite infections.
  Although a bath or dip is not an effective cure for in tank Ich infestations or similar, a bath/dip can increase survivability in severe cases as the bath/dip provides critically needed oxygen to gills/tissues (via the Methylene Blue), as well Methylene Blue will often stain the parasite on the fish and weaken it severely (keep in mind that Methylene Blue was used as an early Malaria treatment, and that Malaria is a protozoan as is Ich and Velvet).
  The use of baths/dips with sensitive fish such as Clown Loaches is often a must in my experience for moderate to severe Ich (Ichthyophthirius) infestations.
  
  Further References:
  *Treatment and identification of Freshwater and Marine Ich, White Spot Disease
  *Treatment and Identification of Freshwater Velvet, Costia


• As an aid to bacterial infections (such as Columnaris) or Saprolegnia (Fungus).
  As with wounds/sores, swabbing or dripping the Methylene Blue directly on areas of infection greatly increases effectiveness.
  
  Further References:
  *Treatment and Identification Columnaris, Saddleback, Cotton Wool Disease
  *Treatment, Lifecycle, and Identification of Saprolegnia/Fungus in Fish


• As an aid to and for treatment of osmoregulation problems in fish such as Bloating and even Dropsy.
  
  Further References:
  *Do Fish Drink, Healthy Fish Osmotic Function
  *Prevention and possible treatment of Dropsy in Fish


• As an aid to ammonia/nitrite poisoning, often as the result of poor handling/shipping and over crowded conditions prior to an aquarist obtaining a new fish.
  The Methylene Blue will be absorbed into the blood, kidneys, and liver where is can help lessen the effect of ammonia and nitrite poisoning.
  
  Further Reference: Aquarium Medications Part 3; Methylene Blue & How it Works

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What is Better; a Bath or Dip?

This is a subjective question that can not be simply answered however I will give some generalizations.
A properly performed bath is much less stressful to the fish than most disease that they are being treated for. The most stressful part is capture of the fish which can be minimized with a breeder/holding net or proper netting.
In fact I have seen fish bounce back from baths within a hour, especially when the use of stress reducing and medicated water conditioner is used directly on the fish and in the water as the fish is returned to the aquarium. The best product for this by far is the professional water conditioner AAP Res-Q.

Resource: AAP Res-Cue/Res-Q

So with this in mind a mild to moderate infection or for many quarantine purposes the bath is the better choice.
As well almost any injury is better treated with a bath since stress is a major factor with an injury.
I often use baths over in tank treatments where “tank wide infections” are not present so as to not interfere with the biology of the aquatic environment in any way.

A dip is often a choice of last resort for seriously ill fish, especially with Dropsy, bladder infections or other infections causing osmoregulation problems.
One exception for healthy fish where I often choose a dip over a bath is for the prevention of Ich, Cryptocaryon, Oodinium and similar parasite infections.
I have not seen a healthy fish ever succumb from a dip when used for this purpose and a dip is nearly 100% effective for such prevention in marine fish, however less effective and more harsh for freshwater fish (provided there is not latent infection already in the aquarium).

A dip is NOT a good choice for seriously injured fish or fish that have considerable open tissue due to infection, as the dip will often make this worse by extracting necessary body fluids that are already being lost. For these fish, the bath is the vastly better choice.

Performing a Fish Bath

(expanded from Aquarium Disease Prevention);

A bath can be performed in as little as 1 quart of water, in a 1 gallon Rubbermaid (or similar) container or a small BARE tank. Generally the larger the better since it is easier to maintain dissolved oxygen levels and figure out the amounts of medication (if used) in larger containers
If I use a 1 quart container, I would use 1/4 teaspoon of salt and several drops of MB (I also recommend rubber gloves and old towels, rags, paper, etc spread around since Methylene Blue is messy and stains).

The schedule is generally 20-30 minutes at least once per day, twice if the fish will tolerate this frequency.

For freshwater I would add Methylene Blue at double normal tank treatment strength (as per bottle instructions) then add salt (NaCl) at about 1 teaspoon per gallon. With the Premium AAP 5% solution "MethyBlu" (recommended), this means 2 drops per gallon
Epsom Salts can also be used too at 1/4 teaspoon per gallon in baths used for treatment (some use higher amounts, but I find this works well when combined with sodium chlorides salt). Epsom Salt is especially useful in cases of bloat, water retention, swim bladder issues, etc. This salt should be pre-dissolved prior to introduction of fish to prevent burning of gills.

The salt (regular salt; NaCl) can be increased for difficult treatments (such as Columnaris), especially with salt tolerant fish such as livebearers. Sodium Chloride (NaCl salt) is not only helpful for many external bacterial issues, it also acts to pull fluids through the fish' body often helping with internal osmorgulation issues.
It is best to slowly add dissolved salt to increase levels gently in salt amounts over 3 teaspoons per gallon, even in salt tolerant fish.
Generally for most fish (even catfish based on University of Florida studies) 2 teaspoons per gallon can be tolerated for up to 30 minutes (many fish can tolerate 4 teaspoons per gallon), although if unsure about your fish’ tolerance, gradually add the salt via a dissolved solution during the first half of the bath.

Epsom salts (Magnesium Sulfate) are useful for baths (I do not recommend even short term use in the main display aquarium) in either fresh or saltwater where internal issues are suspected, including constipation and lack of appetite.
This said, Epsom salts are generally not enough alone except for very specific internal bloating issues and other more specific medications will need to be added to the bath (read further in this article, including references/resources).

IMPORTANT TIPS; Please Read Before Performing a Fish Bath:

• I recommend keeping the “bath” container in a location that does not allow the temperature to drop more than 2 degrees during this time so as to prevent shock when transferred back to the holding/display tank.


• If at all possible I recommend keeping the fish that are being given baths in a Breeder Net Box (see picture) or similar in the tank or in another filtered bare tank so as to make capture easy and less stressful for both you and the fish.
  If too much stress is incurred capturing the fish for each bath, this can negate the positive effects of the bath.
  Product Source: Lees Breeder Net/Box for Sick Fish, Bath Holding


• Netting the fish can be stressful to both the fish keeper and the fish, so the above suggested holding tank container can help here.
  If possible, simply cupping your hands or using a ladle will lower risks of fin damage and loss of slime coat via net capture.
  
  That said, remaining calm yourself goes a long ways in preventing stress & injury to the fish to be given a bath, dip or swab. Often injuries only occur to the fish because the fish keeper is nervous and this results in rough handling. I personally have netted many fish over the years for baths, dips or swabs with no injury whatsoever.


• ALL baths should start with water from the fish’ holding tank's water, so as to avoid pH and temperature shock.
  As well, ALL baths should have fresh Methylene Blue, salt & other medications if used, otherwise many medications can and will degrade and be less effective or even toxic in some cases.
  The bottom line here is to throw away all bath water after completion of each and every bath, NEVER reuse bath water from a previous bath, even if just used hours earlier!!!
  
  HOWEVER, do not worry if a tiny amount of Methylene Blue or other chemicals/medications is added to the main aquarium when transferring the fish back after the bath.


• Floating pre-made large fish bags of the dip water (with salt, do not add medications until immediate use).
  While this is not essential, this can make the bath process easier as everything is ready to go when you may be in a hurry. As well this allows for the correct water temperature.


• Although most bottles of Methylene Blue do not come with a dropper any more (the premium AAP MethyBlu comes with a dropper style bottle), I recommend finding a dropper that will fit the bottle or use an eye dropper so as to limit MB stains/mess.


• Since mineral cations can help with stress (in part due to improved Redox Balance), I recommend to use a product such as the Wonder Shells in the bath water (also dip water too).
  You can break off a piece of Wonder Shell for this bath, then leaving this piece in the bath for the duration of the bath to add these mineral ions.
  Product Source: AAP Wonder Shell; Fresh, NOT clearance (BEWARE of Copycats from Amazon and Aquarium Co-op, INSIST on the genuine fresh Wonder shells only at AAP)


• Be careful of too many or too large a fish in too small a volume of water, as dissolved oxygen can be quickly depleted. A fish "starving" for oxygen defeats any benefits a bath might provide.
  Consider an air stone in the bath water to address this potential issue.


• I generally do not recommend baths for larger fish (unless you are sure of your fish handling abilities), such as over 6-8 inches (15- 20 cm.), as often handling of these fish can be difficult and cause quite a mess.
  As well larger fish can be more easily injured due to the difficulty in handling them.
  However, if a larger fish is in poor condition and question arises that the fish is already in a severely weakened condition, a bath or better, a dip may be attempted (see below for more about “dips”).
  As noted earlier in this article, a way around this is to house your large fish in a separate large hospital tank that becomes their bath for 30 minutes once or twice per day, then is flushed with water from the display tank after the bath, while the display tank gets fresh water.


• For saltwater fish, dilute the saltwater to 1.015 or even 1.009 (specific gravity), making sure your pH stays up by adding any buffers necessary before adding fish (1.009 is a must for Cryptocaryon prevention/removal).
  The purpose of adding or lowering salt (whether SW or FW) is to change osmotic pressure which is an aid to parasite removal as most parasites such as Ich or Cryptocaryon cannot tolerate these changes as well as fish.


• With freshwater fish, AAP/SeaChem StressGuard or AAP Res-Q are good follow ups to a bath, dip or swab.
  The professional choice, AAP Res-Q, is preferable over Stress Coat as it tend to be more attracted to the fish epidermis when squirted directly on the fish when releasing back into the aquarium and adds Sulfa & quinine hydrochloride to aid in healing.
  
  Product Resource: AAP Res-Cue/Res Q


• Finally, Do not add bath water back to your aquarium (a small inadvertent amount when adding back fish is not going to to create issues with your aquarium water).
  However continued addition of all Methylene Blue & other chemicals, salt, medications, etc. can destroy your nitrifying bio filter bed or cause other water quality issues.

Please see the video at the end of this article for more help in understanding the process of a fish bath

Further Bath Tips from Everything Aquatic Member Fishfever

1. Always spread out an absorbent mat around the tank before doing anything to catch drips (and especially Methylene Blue, ***IT REALLY STAINS IF IT GETS ON ANYTHING ***). Gloves are good too to avoid the blue finger syndrome!


2. Premixing the salt with tank water in a large container saves time if you plan to give a number of baths. You could probably premix the MB also (not sure) but would not mix Potassium Permanganate since it reacts with tank water (I think it removes dissolved organic compounds in the tank water).
   I use an eyedropper to get the proper fraction of a teaspoon to gallon ratio for the Potassium Permanganate in the small bath container or double bag (it's not a perfect ratio but it's consistent).
   Product Source: Potassium Permanganate from AAP
   
   Further Information: Aquarium Medications 3; Potassium Permanganate


3. If possible, give your bath in a container or double bags within the tank.
   This way the bath stays heated to the same temperature as the tank and if the fish jump they just jump into the tank. I fill my bath container or double bags just enough so they still float and the buoyancy pushes the container up against the rim and top cover, keeping it from trying to flip over.
   If you overfill the bath container will sink. Remember to float the bath container or bags in your tank long enough to equalize temperatures.


4. Since I have to give twice daily baths, I leave the fish in a small breeder net (about 6"x6"x4") overnight after the evening bath which I do just before I shut the tank light out and go to bed. This saves me from having to catch the fish for the morning bath, i.e. only have to catch her once a day for the evening bath.

Bath/Dip Risks

Obviously there are risks in the performance of a fish bath or dip, however in fish less than 6 inches these can often be minimized as per previously suggested tips.
For minor injuries or infections sometimes the risk of stress is simply not worth the bath, HOWEVER in my experience with literally 100s (if not 1000s) of baths/dips the risks for most applications is far less than the alternative.
Even with 'extreme' freshwater dips used for saltwater fish, whereby the fish will react as if they are dead, the fish will generally “snap out of it” in a matter of hours and will be better than before this dip.
Most baths are much less stressful than the previous example, so any observed stress will pass quickly if the bath is performed correctly.

As well in many cases such as sores or diseases, the use of a bath will allow for a more mild in tank treatment which is quite bluntly better for long term aquarium health than dumping in “tons” of harsh medications (especially when a hospital/treatment tank is not available).
The bottom line is to not let the bath/dip stress you more than the fish, as this procedure can often mean the difference of a successful treatment and an unsuccessful treatment especially in severe cases of Ich (this is especially true with sensitive fish such as Loaches) or in often difficult to treat bacterial infections such as Columnaris.

Further References:
*Aquarium Ich in Freshwater or Saltwater
*Columnaris & Fungus in Aquariums

Medications in Baths;

Another option to baths is IN ADDITION to the salts and Methylene Blue, but NOT combined with Potassium Permanganate, is you can safely add many antibiotics at double normal "in tank" recommended dose for the 30 minute bath. This can both increase the effectiveness of the bath and the antibiotic added.

Before I go on here, it is noteworthy that with any aquarium/pond fish treatment it is important to know all the steps as often treatment is much more than a medicated fish bath or dumping medication into an aquarium.
Please read this article before ANY aquarium treatment regimen:
Fish Diseases | How to Treat Sick Fish

Medications that generally are good choices for baths are;

• AAP Nitrofuracin Green; Synergistic Nitrofurazone, Sulfathiazole Sodium, & Methylene Blue Full Spectrum Treatment
  Probably the FIRST CHOICE for a fish baths since this blend is wide spectrum bacterial, fungal, and even anti-parasitic. As well this product already includes Methylene Blue so this negates the use of Methylene Blue in your fish bath wif this medication is used. Use this at double aquarium/tank dose.
• Metronidazole
  A good choice for intestinal infections since it is not readily absorbed through the intestines.
• AAP "Yellow Powder"; Premium Nitrofurazone
  For Aeromonas, Saprolegnia, Furunculosis, & serious cases of Columnaris.
• AAP Kanaplex (Kanamycin)
  OR Minocyline for Columnaris (mild cases when used by itself), Dropsy, or PART of a treatment for Pop-Eye.
• AAP Sulfaplex; Sulfathiazole; a good option (not combined with other antibiotics/anti-microbials) when there wounds, abrasions, etc. as the root cause of an external infection. While generally not the first choice for Pop-eye, it can be if a wound or similar is the cause.
  
  Further Information: Aquarium Medications Part 2; Sulfathiazole


• Malachite Green can also be added to Methylene Blue to increase effectiveness for fungal infections as well as parasites.
  Recommended Resource: AAP Seachem Paraguard (Zinc Free MG)
• AAP Pipzine is a good choice for: Unexplained Fish Death, Gourami Disease, & Gasping & Surface Breathing.
• While primarily meant as a fish food soak, AAP Discomed is still a good choice for Color Loss, Weight Loss and Wasting, Darkened Body Color, Skinny Body, & Concaved Abdomen; ALL as a result of parasitic infections.
  This product also already contains NaCl, Piperazine & Magnesium Sulfate, so these salts need not be added to the fish bath.
• Usnea is an experimental alternative that has similar properties to Metronidazole and can also be effective for some viruses and possibly tumors. I use about 1 tablespoon per 6 oz. preparation for a 1 quart bath.
  Please see this article for more about the use of Usnea:
  Usnea as a Fish Disease Remedy

Alternatives to Methylene Blue

Acriflavin, at double recommended tank dose can be substituted for Methylene Blue for treatment baths for ailments such as wounds, and very stubborn fungus infections (which can be common in bettas kept in confined spaces).
Product Source: API Yellow Powder, Nitrofurazone & Acriflavin

Kordon Fish Therapy Curative Bath, This is an all natural fish bath developed by Kordon containing natural therapeutic oils (including citrus, neem, and lavender oils), and aloe vera.
However do not be fooled thinking that just because it is natural, it is therefore better, as this is NOT a replacement of Methylene Blue for fish suffering from ammonia poisoning, low oxygen damage, pH shock, or other bath medications for more serious problems.

This product is best used without any other medications as an alternative treatment or preventative for suspected mild to some moderate problems, in particular if parasites are suspected (either internal or external). Use with salts is OK and suggested for moderate to serious issues (either or both Epsom Salt or Sodium Chloride).

Potassium Permanganate (at double recommended tank dose) can be substituted for Methylene Blue for treatment baths for ailments such as Flukes, cloudy eyes, & some stubborn parasite and bacterial infections such as Columnaris(generally Potassium Permanganate is the better choice for Columnaris unless the fish is displaying rapid breathing or is on "death's door").
Product Source: AAP/Jungle Potassium Permanganate, Clear Water

HOWEVER for "pure" preventative baths, ammonia poisoning or unknown problems, Methylene Blue is by far the better choice.

Unlike Methylene Blue; DO NOT mix Potassium Permanganate with antibiotics.

See this article under Potassium Permanganate or Methylene Blue for more:
Aquarium Medications; Chemical Treatments.

Another key point is that Methylene Blue can quite SAFELY be overdosed as it takes high amounts with long term exposure to be toxic, while Potassium Permanganate should NEVER be overdosed.

CAUTIONS About the Use of Potassium Permanganate for Baths & Painting (Swabbing) Infections:

Since Potassium Permanganate is strong oxidizer, caution should be exercised in usage for baths and especially as direct application for external infections (unlike Methylene Blue which is very difficult to over dose).
For most fish, a double dose of the normal 'in tank' recommended dosage is used.
This varies from product to product, however using Jungle Clear Water as an example; the recommended tank dosage is 5 mL per ten gallons, so the bath dosage would be 10 mL per ten gallons (or 5 mL per 5 gallons of “bath” water).
Fish such as many Tetras, Loaches, and similar “sensitive” fish should be given consideration in dosage of Potassium Permanganate.

An even more important consideration is the use of Potassium Permanganate for direct application/swabbing of certain infections such as external symptoms of Columnaris or Saprolegnia/Fungus (see the next section for more about swabbing/dips).

Potassium Permanganate should be diluted at least 3/1 up to 2/1 (water/PP) for this use and often more so depending upon the fish in question (testing on a healthy part of the fish in question or a related fish may help determine tolerance).
As well do NOT use even diluted PP anywhere near the gills of a fish, or on fish tissue showing signs of necrosis [1], THIS CAN BE LETHAL.
Use a diluted PP swab ONLY on areas of actual Columnaris, Saprolegnia, or related infection such as the common "Saddleback" often seen in Columnaris or the fuzzy growth areas of Saprolegnia.

If Potassium Permanganate or Hydrogen Peroxide is accidentally applied directly to the gills, an immediate 3-5 minute dip in water with a 2-3 x normal dose of SeaChem Prime or other similar water conditioner is a must!
The use of AAP Res-Q or Prime or other similar water conditioner at double strength in a 2-5 minute dip (using tank water) is also strongly suggest after a bath using Potassium Permanganate or Hydrogen Peroxide if only to help restore the slime coat and restore the fish Redox Balance since most aquarium water conditioners are temporary Redox Reducers.

Product Sources:
SeaChem Prime, Temporary Redox Reducer AAP Res-Q; Premium Medicated Bandage, Reducer, & Slime Coat Protector

Further Information: Aquarium Water Conditioner Review

Please note that this point of dilution does NOT apply to Methylene Blue which is safe to use full strength, even around gills (although internal gill application is best performed via a bath, not a swab).

Dips, Swabbing (Swabs), etc.

In a dip, I again adjust pH and add Methylene Blue, HOWEVER in the case of the marine fish, I will use a specific gravity of 1.001 (basically a freshwater dip) and a specific gravity of 1.012 of 1.015 for the freshwater fish (2.3 oz. or approximately ¼ cup of fine salt per gallon) which is basically a saltwater dip.
This dip should be no less than 3 minutes and no more than 5 minutes to be effective.

For known problems (or sometimes as a preventative for new fish especially as a Cryptocaryon or Oodinium in marine fish) a 3-5 minute dip is sometimes even more effective, albeit more stressful to the fish (more stressful for freshwater fish than saltwater fish).
The picture to the right displays an Ocellaris Clownfish in freshwater dip for Oodinium treatment.

To lower the stress a high salt dip for freshwater fish or a freshwater dip for marine fish it is advisable to use the first 2 minutes (of a 5 minute dip) slowly introducing the saltwater (or freshwater for marine fish) until the fish is in the desired salinity water for the remaining 3 minutes.
Make sure that the water added slowly during the first 2 minutes is pre-mixed with salt prior to use for freshwater fish or pre-adjusted for pH for marine fish.

A dip is often a better choice than a bath for a large or otherwise “spastic” fish due to the much shorter duration.
As well a dip, albeit much more harsh than a bath (when used as described), may be a better choice for a very ill fish that may be “at deaths door” and the risks of a dip are low when compared to the fact of the probable imminent death of the fish anyway.
A dip is also a good choice for problems that stem from fluid build-up and poor osmotic function, such as many causes of “Pop-Eye”.

*I also use dips to replace quarantine when quarantine is not possible for fish of questionable sources; especially with marine fish as a dip is nearly 100% effective for destroying Oodinium or Cryptocaryon on marine fish (the osmotic pressure causes the parasite cells to burst). Keep in mind that the dip does not destroy these parasites in the water column if the disease has already been accidentally introduced.

Further Reading:
*Oodinium in Marine Fish
*Marine Ich, Cryptocaryon

*SWABS:

Another similar idea is to directly drop or “paint” with a Q-Tip (or similar implement) Methylene Blue, Mebromin (AAP Wound Control), Potassium Permanganate (diluted), tincture of Iodine, or Hydrogen Peroxide onto a problem area such as Saprolegnia/fungus, Columnaris, Ichthyophonus, or similar.
This can be VERY effective for stubborn external infected areas on a fish (such as node on fish tails, etc.) as well as a first response to a wound or injury.

The negative of swabs is these can be even much more difficult to perform for a nervous fish keeper than a bath, so staying calm is very important. As well, while remaining calm, it is best to firmly but gently handle the fish so as to prevent injury. I prefer using my hands once captured, not a net.
For larger specimens I will use a smooth container with square sides to more easily hold the fish firmly.

Methylene Blue is safe to use for exposed tissue, which will stain blue, but this is not a danger unless grossly over used. However since MB is not very strong, if the area treated still has a slime coat, MB will likely not penetrate well (a swab may not also be called for in such an instance).

The use of Methylene Blue at full strength (in a typical 2.303% solution or concentrated MethyBlu) as a swab, dip, and to a lesser degree a bath will also expose healthy or at least normal tissue as Methylene Blue will generally adhere to infected areas or wounds staining the area “blue” due to the lack of the normal “slime” coating fish have on healthy areas of a fish’ epidermis.
Even scar tissue will generally not stain “blue”, so this a good test of whether or not a “growth/sore” is actually an infection or similar (please note that some cancers/tumors can mimic healthy tissue and not stain blue).

Another alternative to a straight Methylene Blue swab or drops is Mebromin
In fact prior to the demise of availability of this Mebromin around 2002, this was my swab or drop chemical of choice for many applications over Methylene Blue.
While Mebromin does not have the benefits of dying exposed tissue (showing where tissue is compromised) and transport of oxygen to cells, it actually is far more effective for exposed injuries/wounds and severe infections caused by opportunistic bacteria with just as much safety margins as Methylene Blue (unlike Potassium Permanganate and Hydrogen Peroxide) but is vastly more effective for bacteria such as Columnaris and in fact is the swab/direct application of choice in such bacterium.

For really serious exposed infections, such as flesh eating bacteria (which is difficult to treat), is a combination where the aquarium fish keeper first uses AAP Wound Control to stop & kill the infection, followed by placing the sick fish in a holding container for 5-10 minutes then follow with a MethyBlu swab which although not as effective on bacterium, it is better at promoting healing and getting oxygen to sick tissue.

Product Resource: AAP Mebromin (Wound Control)

For serious infections such as advanced cases of Columnaris/Sadddleback Disease, a swab with Merbromin (AAP Wound Control) or Potassium Permanganate (as discussed earlier in the article in detail) should be performed, then possibly follow a couple hours later with AAP/SeaChem StressGuard.
As already noted, some sores, blisters, tumors, etc., may not allow adhesion of Methylene Blue/MethyBlu and AAP Res-Q may not be enough, this is where the use of Merbromin or maybe Potassium Permanganate may be called for.
Please Review "Potassium Permanganate Cautions" before using.

If Potassium Permanganate or Hydrogen Peroxide is used as a swab; placing the fish into a quick dip utilizing a double dose of any Redox Reducing Water Conditioner such as SeaChem Prime,AAP Res-Q, or AAP Sheildex can immediately stop any unwanted oxidation of Potassium Permanganate on the fish.

Product Sources:
Prime Aquarium Water Conditioner from AAP
Potassium Permanganate; Clear Water from AAP

Further Information about Redox: Aquarium Redox

After swabbing, the use of AAP/SeaChem StressGuard in the aquarium is suggested.

Product Resource:
StressGuard from AAP

For stubborn Fin rot or infections direct application of 3% Hydrogen Peroxide via swab has been successful on many occasions.
Further Information: Aquarium Medications 3; Hydrogen Peroxide

Potassium Permanganate (this should be diluted approximately 50% to 60%, unlike Methylene Blue) & Hydrogen Peroxide are generally more effective for the above noted infections.
However open sores, wounds, and in particular gill problems should Not use Potassium Permanganate.

Hydrogen Peroxide or tincture of Iodine may be used (EXCEPT for gills), however Methylene Blue is a better choice direct gill applications where PP or Hydrogen Peroxide will burn the gills and often kill the fish as a consequence.

If Tincture of Iodine is used as a swab, a quick dip into some "throw away" water after the swab can help prevent toxic levels of iodine in the aquarium due to excess iodine on the fish after the swab.

Any of these swabs can also be used in conjunction with baths and "in tank" treatments too.

Finally, for stubborn fungal infections, Acriflavin (found in API Fungus Cure) is another good swab choice, especially for Bettas normally kept in small tanks/bowls.

CORAL, ANEMONE DIP OR BATH

Often a dip of anemones or coral (such as Acropora corals) is necessary to remove bacterial, parasites, planarian, etc.
Further Reference: Fish Parasites, Flatworms, more

A simple freshwater dip using de-clorinated freshwater adjusted to the pH of the water of the saltwater containing the specimen to be dipped is often "good enough" for many problems.
This should be between 3-5 minutes to be effective for "bugs" such as Oodinium.

Iodine Baths are excellent for some potential parasites of corals such as flatworms.
For a home method, the use of Tincture of Iodine 2.5% can work well and is available over the counter at most drug stores.
Use 1 Liter (approximately 1 quart) of Tank water, then added 20 drops of Tincture of Iodine 2.5%. Then fill a second container with tank water only, this is for rinsing dipped (bathed) corals.

Place your corals including both SPS and LPS in this bath for approximately 20 minutes (do NOT exceed 25 minutes).
This is followed by rinsing the corals gently in the rinsing the corals for about 30 seconds with a swirling motion.

An excellent and SAFE product to use is SeaChem Reef Dip, which contains elemental iodine complexed to a protective slime coat for safely and gently disinfecting corals.
SeaChem Reef Dip can be used prophylactically or to remedy diseased specimens. It is safe to use with both stony and soft corals. It is also safe for anemones and polyps.
Product Source: Reef Dip; Contains Elemental Iodine Complexed to a Protective Slime Coat

A FEW HELPFUL CONVERSIONS

(Use accurate teaspoons, not silverware):

• Teaspoon = 4.929 mL
• Tablespoon = .5 fl. oz. = 14.787 mL
• For mixing salt for a dip; 1/2 dry cup will make a specific gravity of about 1.023- 1.025;
  For 1.015 specific gravity for a dip, use approximately 1/4 to 1/3 dry cup.

Fish Bath Video;

Feedback

Carl,

Just like to thank you for the information. Our fish is doing GREAT! I wish I had a before and after picture. He had turned completely black lost so much weight and his tail was almost completely gone. I really didn’t think there was much of a chance that he’d make it. I did the fish baths with Aquarium salt, Methyl Blue, Kanaplex, and Metronidazole for 10 days. Now he has gained weight and has almost caught back up w/ our other fish. He has turned back completely to gold except his fins which were black to start with. Its truly amazing. My girls would have been heartbroken if he had not made it.

Thanks again.
Jennifer Arnder

Glossary of Terms

*[1] Necrosis: Localized tissue death that occurs in groups of cells in response to disease or injury. This often results in large growing sores and exposed deep tissues of the fish.

Related Tips:

If you use a UV Sterilizer for Fish disease prevention and improved Redox (for fish immunity improvement), it is important to change the UV Bulb every six months for maximum effectiveness!

Product Sources:
*Aquarium, Pond UV Sterilizers
*Premium Low Pressure UV-C Replacement Bulbs/Lamps, Page One

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Labels: fish bath, fish dip, fish quarantine, fish swab, methylene blue treatment, sick fish