Female Mustang is Sick! HELP!!

Dear Ken:

I received your e-mail describing the problem with your female seahorse and I have studied the picture that you sent closely. In my experience, suspicious white spots such as this are most often the initial stages of a bacterial infection, which you can consider to be a form of skin rot. However, irregular white patches can also be the result of parasitic skin infections, and the scratching the female has been doing can indeed be an indication of the irritation caused by such parasites (although bacterial and/or fungal skin infections are also irritating and can result in scratching or itching). Various protozoan parasites attack the skin, and the damage to the integument that results allows secondary bacterial and/or fungal infections to develop, resulting in pale patches and irregular areas of depigmentation.

In short, the white area appears to be a bacterial lesion that is just beginning to develop, but I cannot be certain if it is a primary infection or a secondary bacterial infection associated with protozoan parasites. In any case, the photograph indicates the early stages of ulcerative dermatitis or marine ulcer disease, and if it is left untreated the white spot will develop into an open sore or ulceration and the tissue erosion will begin eating into the underlying musculature. Such infections are most often associated with Vibrio or Pseudomonas bacteria.

At the first sign of a problem like this, it’s important to isolate the affected seahorse so that the rest of the herd isn’t exposed to the same pathogens, and to begin treating the seahorse aggressively in isolation with potent broad-spectrum antibiotics immediately for at least 10 days. The medications that are most useful in resolving Vibrio infections are chloramphenicol (i.e., Chloromycetin), which you probably will not be able to obtain, Baytril, which is a prescription antibiotic that may also be difficult for you to obtain, or a combination of doxycycline + kanamycin, both of which can be obtained from National Fish Pharmaceuticals without a prescription. Furan2 or Nitrofuracin Green are also sometimes helpful when the infection is detected early on, and Furan2 is available from many well-stocked pet shops and fish doors. I will provide you with instructions for using these antibiotics later in this message. And I would also recommend administering a series of formalin baths in conjunction with the antibiotic therapy, in order to suppress any protozoan parasites that may be involved.

Here is some additional information regarding marine ulcer disease to give you a better idea of what I believe you are dealing with, Ken:

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MARINE ULCER DISEASE, A.K.A. ULCERATIVE DERMATITIS, A.K.A. HEMORRHAGIC SEPTICEMIA, A.K.A. "FLESH-EATING BACTERIA"

Marine ulcer disease is a particularly nasty type of infection that most hobbyists have come to know as "flesh-eating bacteria," and indeed it can often be attributed to bacteria, most notably Vibrio or Pseudomonas species (Giwojna, Nov. 2003). Vibrio in marine fish is the equivalent of the Aeromonas bacteria that plague freshwater fishes (Dixon 1999; Basleer 2000), causing external hemorrhagic ulcers (bloody lesions). Vibriosis is probably the most common bacterial infection of captive seahorses and one of the most difficult to eradicate from your system. Vibrio bacteria are motile gram negative rods, which measure about 0.5 X 1.5 micrometers (Prescott, 2001). When grown on suitable media they appear as shiny, creamy colored colonies (Prescott, 2001).

Marine ulcer disease or hemorrhagic septicemia can manifest itself in a number of forms. The most common of these are the external hemorrhagic (bloody) ulcers, which appear as localized open wounds on the body (Dixon, 1999). It may be helpful to think of this condition as a form of skin rot. The first symptoms are usually small, discolored areas of skin or localized areas of depigmentation that often become red and inflamed as the condition progresses (Giwojna, Nov. 2003). These may become large bloody spots or lesions (the characteristic ulcers) as the disease progresses, leading to sloughing of the skin and localized swelling (Giwojna, Nov. 2003). (I have found that many times hobbyists have a tendency to dismiss these ulcers as "heater burns," especially when they appear on the flanks or pouch of the seahorse, and to delay appropriate treatment on the basis of this misdiagnosis. Avoid this all-to-common mistake!) In severe cases, the underlying musculature also becomes infected, and the rapid tissue erosion that can result is one of the most alarming aspects of ulcer disease. At this advanced stage, the infected fish can longer be saved (Giwojna, Nov. 2003).

Badly infected fishes may develop a distended, fluid-filled abdomen due to internal bacterial infection (septicemia) of the kidneys, liver or intestinal tract (Dixon, 1999). This disrupts the normal circulation of the blood and lymph, causing fluids to accumulate in the intestine and abdominal cavity (Dixon, 1999).

The most dangerous form of hemorrhagic septicemia occurs when the bacteria spread internally and become septic, infecting the blood (Dixon, 1999). The bacteria release toxins into the bloodstream, making it the most virulent of these infections (Dixon, 1999). This insidious form of the disease does not produce the telltale external ulcers, and acute infections can kill quickly with little warning due to the lack of outward signs (Dixon, 1999). Affected fish become listless and lethargic (Dixon, 1999), which may be hard to pick up on with seahorses. Respiration is rapid and seahorses usually darken in color and go off their feed. These behavioral indicators are especially difficult to detect in seahorses due to their lazy lifestyle and habit of changing colors frequently. Seahorses may succumb to the acute form of this disease before the aquarist realizes anything is amiss, and hobbyist often ascribe such mysterious losses to Sudden Death Syndrome.

In seahorses, this disease sometimes takes the form of bilateral edema of the periorbital tissue (Bull and Mitchell, 2002, p19). The eyes themselves are not affected, as in popeye or Exopthalmia; rather, the tissue around both eyes swells up. The eyes are thus unaffected but are encircled by rings of swollen tissue. Hobbyists have described this condition to me by saying that their seahorse had developed "doughnut eyes." These characteristic doughnut eyes are often accompanied by swelling of the soft tissue around the tube snout (Bull and Mitchell, 2002, p19). Some cases develop this peculiar facial edema as well as the usual skin ulcers and tissue erosion (Bull and Mitchell, 2002, p19).

Hemorrhagic septicemia or marine ulcer disease can be a very stubborn and difficult infection to treat, especially when it is due to Vibrio and the disease is acute or advanced. However, if the condition is detected early and treatment is begun when the discolored patches of skin or other symptoms are first noticed, antibacterial agents are often helpful (Giwojna, Nov. 2003). The professional aquarists treat this disease aggressively, using bivalent Vibrio vaccines, immunostimulants such as a beta-glucan, and injections of antibiotics (Bull and Mitchell, 2002, p19).

Aside from administering beta glucan (a primary ingredient in Vibrance) orally, such measures are beyond the grasp of we home hobbyists. We must make do by treating the affected specimens in isolation using wide spectrum antibiotics such as chloramphenicol, enrofloxacin (brand name Baytril), doxycycline, kanamycin, oxytetracycline (orally), neomycin sulfate, sulfonamide or streptomycin, or Furan2 or Nitrofuracin Green (in mild cases that are detected early). As with other bacterial infections, lowering the water temperature during the course of treatment can help a great deal. This is your best course of action when you are confident that the problem is due to a bacterial infection, such as Pseudomonas or Vibriosis (Giwojna, Nov. 2003).

Chloramphenicol is the treatment of choice. It can be given orally or used as a bath (Prescott, 2001c). Therapeutic baths lasting 10-20 hours are administered in a chloramphenicol solution consisting of 40 mg per liter of water (Prescott, 2001c). If the seahorse is still eating, the chloramphenicol can also be bioencapsulated by gut loading feeder shrimp or ghost shrimp with flake food soaked in the antibiotic solution. Even if the affected seahorses does not eat, feeding medicated shrimp to its tankmates is a good way to help prevent this contagious disease from spreading to the healthy seahorses (Prescott, 2001c).
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All things considered, Ken, I would say that chloramphenicol (i.e. Chloromycetin) is the treatment of choice for marine ulcer disease (i.e., flesh-eating bacteria) and most Vibrio infections, in general. It is effective both as a bath for prolonged immersion or when administered orally. If the affected seahorses are no longer eating, then administering the chloramphenicol to the treatment tank would be a good option for you if your other seahorses develop any symptoms of this disease.

The treatment protocol for Chloramphenicol or Chloromycetin is as follows:

Chloramphenicol can be used to treat Vibriosis at 40 mg/ litre of water (which comes out to about 150 milligrams per gallon) in a bath for 10-20 hours. It is important to watch the quality of the water, and if it starts to become turbid, the water must be changed. It is best to treat in a separate tank. In stubborn cases, a series of such baths may be necessary to resolve the problem, in which case a complete water change should be performed before the medication is redosed.

Chloramphenicol can also be used as an additive to the feed, if the fish are still eating (all to often in a major infection they will refuse to eat, but this treatment may be most useful in preventing the horizontal spread of the infection). When used as an addition to the feed use 500 mg per 100 gram of feed. (In the case of seahorses, the flake food medicated with chloramphenicol in this way would first be bio-encapsulated in live feeder shrimp, which would then in turn be fed to the seahorses.)

If you do obtain the chloramphenicol, be sure to be very careful when handling it. Remember, in a few rare individuals exposure to chloramphenicol can cause a potentially fatal side effect (aplastic anemia). These are rare cases and almost always involve patients who were being treated with the medication, but I would use gloves when handling it as a precaution and if you crush crush up tablets of chloramphenicol, be very careful not to inhale any of the power.

Because of this side effect, which affects one in 100,000 humans, chloramphenicol is no longer available as a medication for fishes and can therefore be difficult to obtain. If you find that is the case, your next best alternative is to obtain doxycycline and kanamycin from National Fish Pharmaceuticals and use them together to form a synergistic combination of antibiotics that is often very effective in treating Vibrio infections.

Doxycycline hydrochloride

USE: broad spectrum antibiotic derived from oxytetracycline. Use for both gram-positive and gram-negative bacterial disorders, including fin and tail rot, septicemia, and mouth rot. Unlike tetracycline antibiotics, it will not be deactivated by the high pH levels found in marine aquaria. Works in a similar manner to chloramphenicol.

DOSAGE: add 1/4 teaspoon per 20 gallons, every 24 hours for 10 days. Do a 25% water change before each treatment.

Kanamycin sulfate

This is a potent broad-spectrum, gram+/gram- aminogylcoside antibiotic. It is wonderfully effective for aquarium use because it is one of the few antibiotics that dissolves well in saltwater and that is readily absorbed through the skin of the fish. That makes it the treatment of choice for treating many bacterial infections in seahorses. Kanamycin can be combined safely with certain other antibiotics such as doxycycline or neomycin (as well as metronidazole) to further increase its efficacy. Like other gram-negative antibiotics, it will destroy your biofiltration and should be used in a hospital tank only.

USE: gram-negative bacterial infections and resistant forms of piscine tuberculosis (mycobacteria). Works especially well in saltwater aquariums.

DOSAGE: add 1/4 teaspoon per 20 gallons. Treat every 24 hours and perform a 25% water change before each treatment. Treat for 10 days. (When treating piscine tuberculosis, treat for 30 days.)

Both the doxycycline and kanamycin can be obtained online from National Fish Pharmaceuticals without a prescription at the following URL:

http://www.fishyfarmacy.com/products.html

Enrofloxin (brand name Baytril) is another good antibiotic for treating ulcerative dermatitis and tail rot, but it is a prescription medication that you would need to obtain from your family Vet. It would be your next best option if you cannot obtain the chloramphenicol or the doxycycline hydrochloride + kanamycin sulfate.

Baytril is a potent new broad-spectrum antibiotic that is effective against both gram-negative and gram-positive bacteria and is widely used to treat marine fish. Instructions for administering enrofloxin/Baytril are as follows, courtesy of Ann at the org:

ENROFLOXACIN Oral Dosage and Preparation Instructions
Active Ingredient: Enrofloxacin
Indication: bacterial infection
Brandnames: Baytril
The following information is based on the most commonly available tablet sizes for Enrofloxacin/Baytril
available in the US and abroad and an average sized seahorse of approximately 10 grams. Moderators
are available in the Emergency and Disease and Treatment forums to assist when working with different
tablet strengths and/or when the exact weight of the seahorse is known.
Tube feed the seahorse 0.1mg of Enrofloxacin once a day for 10 days.
Day 1 – 10 of Treatment
• Crush 1/4 of a 68mg or 50mg tablet into a fine powder.
• Use a mini-blender or small hand-blender to thoroughly mix the powder with marine water. Mix 1/4 of a
68mg tablet with 85mL of marine water. Mix 1/4 of a 50mg tablet with 62.5mL of marine water.
• Fill a small syringe with 0.5mL of the solution.
• Tube feed the seahorse according to the instructions in the tube feeding drawer.
• Throw out the unused Enrofloxacin and marine water solution. You will need to make new solution daily
because Enrofloxacin breaks down quickly in saltwater causing it to become completely ineffective by the
next day.
Important Notes:
Enrofloxacin is available only by prescription from a veterinarian.
Enrofloxacin International Version – Tablets are produced in 15mg, 50gm, 150mg, & a 2.5% injectable
solution
Enrofloxacin US Version – Tablets are produced in 22.7mg, 68mg, 136mg, & a 2.27% injectable solution
If you are able to ascertain the exact weight of your seahorse you may want to adjust the dosage as
necessary to get the most benefit from the medication. In such an instance you would dose Enrofloxacin
at 0.01mg of the medication per gram of body weight.
A veterinarian who works regularly with small exotics will be familiar with the proper way to dilute
injectable Enrofloxacin solution to fit your needs.

If you cannot obtain Baytril, then treating the seahorse with with Furan2 + acriflavine or with Nitrofuracin Green would probably be the next best option.

Furan2 is a good combo medication that consist of two nitrofuran antibiotics (nitrofurazone and furazolidone) plus good old methylene blue. That gives it both bacteriostatic and bactericidal properties, and makes it active against various gram-negative and gram-positive bacteria. The methylene blue stains the water in the treatment tank as and prevents the photosensitive nitrofuran antibiotics from being deactivated by light. Methylene blue is effective in preventing fungal growth, and it has antiprotozoal and antibacterial properties as well, by virtue of its ability to bind with cytoplasmic structures within the cell and interfere with oxidation-reduction processes. This makes the combination of methylene blue, nitrofurazone and furazolidone very broad spectrum and fairly potent.

Best of all, Furan2 can be safely combined with Aquarium Pharmaceuticals antiparasitic medications such as acriflavine to increase its effectiveness and guard against secondary infections.

Thus, when combined with an effective antiparasitic medication, a good combination drug like Furan2 can be the ultimate weapon in your medicine cabinet. It is effective against a wide range of diseases, making it a versatile shotgun for restoring order when trouble breaks out in your tank. When you suspect an infection is at work, but don’t know whether you’re dealing with fungus, bacteria, protozoan parasites or a mixed infection, Furan2 + Aquarium Pharmaceutical acriflavine is an effective combination that produces good results! Furan2 is especially effective for treating mild skin infections.

However, Ken, you have to take special precautions when administering nitrofuran antibiotics such as this because they are photosensitive and can be deactivated by light. That means you’ll need to darken the hospital tank while you treat the seahorse. Do not use a light on your hospital tank, and keep an opaque lid or cover on the aquarium during the treatments. Remove this cover from the aquarium only long enough to feed your seahorse.

You should also be aware that Furan2 will cause discoloration of the aquarium water, turning it a shade of blue-green. This is harmless and can be removed after the treatments using activated carbon filtration.

The appropriate dosages for the Furan2 are discussed below, again courtesy of Ann at the org:

FURAN-2 (immersion) Dosage and Preparation Instructions for a 10g/38L Hospital Tank
Active Ingredient: Nitrofurazone and Furazolidone
Indication: bacterial infection
Disregard package info concerning water changes and duration of treatment. Dose medication daily for
10 days.
Replace the medication in ratio to the amount of water changed daily as needed to control ammonia.
This product is best administered by feeding it to adult live brine shrimp, then in turn, feeding those
animals to the Seahorse. If this is not an option, it may be administered as follows.
DAY 1 of Treatment
• Thoroughly mix one packet of Furan-2 with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.
DAYS 2 – 10 of Treatment
• Perform a 50% water change.
• Thoroughly mix one packet of Furan-2 with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.

FURAN-BASED MEDS (immersion) Dosage and Preparation Instructions for a 10g/38L Hospital Tank
Active Ingredients: Nitrofurazone and Furazolidone
Indication: bacterial infection
Brand Names: Furan-2, Furanase, Binox, BiFuran+, Fura-MS, Furazolidone Powder
Dose daily for 10 days. Disregard package info concerning dosing frequency and water changes.
Replace the medication in ratio to the amount of water changed daily as needed to control ammonia.
This product is best administered by feeding it to adult live brine shrimp, then in turn. feeding those animals to the Seahorse. If this is not an option, it may be administered as follows.
DAY 1 of Treatment
• Thoroughly mix the medication with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.
DAYS 2 – 10 of Treatment
• Perform a 50% water change.
• Thoroughly mix the medication with about 1 cup of marine water.
• Pour the mixture into a high-flow area of the hospital tank.

FURAN-BASED MEDS (oral) Dosage and Preparation Instructions for a 10g/38L Hospital Tank
Active Ingredients: Nitrofurazone and/or Furazolidone
Indication: bacterial infection
Brand Names: Furan-2, Furanase, Binox, BiFuran+, FuraMS, Furazolidone Powder
Feed adult brine shrimp gut-loaded with medication to the Seahorse 2x per day for 10 days.
• Add a small amount of the medication to one gallon of water and mix thoroughly.
• Place the amount of adult brine shrimp needed for one feeding into the mixture. Leave them in the mixture for at least 2hrs.
• Remove the adult brine shrimp from the mixture and add them to the hospital tank.
• Observe the Seahorse to be certain it is eating the adult brine shrimp.

Nitrofuracin Green is another combo medication with similar ingredients that is equivalent to Furan2. It is available from National Fish Pharmaceuticals and the instructions for using it are as follows:

Nitrofuracin Green

A special formula consisting of two nitrofuran antibiotics (nitrofurazone and furazolidone) + methylene blue and sodium chloride.

USE: anti-microbial, anti-protozoan, antibacterial, and anti-fungal. Wide spectrum. Good for newly arrived fish in quarantine situations. Also be good for healing wounds and ammonia burns on newly arriving fish. Widely used for shipping or packing water. Works well for sores on fish in Koi ponds.

DOSAGE: add 1/4 teaspoon per 20 gallons every 24 hours, with a 25% water change before each daily treatment. Treat for 10 days.

In summation, Ken, I would recommend isolating the affected seahorse and treating him aggressively with antibiotics in your hospital tank as soon as possible. The following antibiotics have proven to be effective in treating such infections when they are detected early (I have listed them in order of preference):

Chloramphenicol (i.e., Chloromycetin)
Doxycycline hydrochloride + kanamycin sulfate
Enrofloxin (i.e., Baytril)
Furan2 + acriflavine
Furan2 or Nitrofuracin Green

In addition to the antibiotic therapy, Ken, I would also recommended ministering a series of formalin baths to your female. Formalin baths used in conjunction with these antibiotics will help eliminate any ectoparasites or secondary fungal infections that may be involved, as discussed below:

Formalin Baths

Formalin (HCHO) is basically a 37% solution of formaldehyde and water. It is a potent external fungicide, external protozoacide, and antiparasitic, and is thus an effective medication for eradicating external parasites, treating fungal lesions, and reducing the swelling from such infections. It is a wonder drug for treating cases of Popeye caused by trematodes, and also eradicates external nematodes.

In my experience, provided it is administered properly, seahorses tolerate treatment with formalin very well at therapeutic dosages. For a long term bath the correct dose is 15 to 25 mg/L. [Note: 25 mg/L equals 1 ml (cc) of 37% formalin per 10 gallons of water.] This is done every other day for 3 treatments.

For a short term bath (dip) the correct dose is 250 mg/L. This would equal 1 ml (cc) of 37% formalin per 1 gallon of water. This should be for about 45 minutes to 1 hour. In my opinion, formalin is a safe, effective treatment for parasitic infections in seahorses providing you don’t exceed these dosages and observe the following precautions for administering the medication properly:

Many commercial formalin products are readily available to hobbyists, such as Kordon’s Formalin 3, Formalin-F sold by Natchez Animal Supply, and Paracide-F, sold by Argent go to top Chemical Laboratories. Or whatever brand of formalin is available at your fish store should work fine, Pam.

A formalin bath simply involves immersing the seahorse in a container of saltwater which contains the proper dosage of formalin for a period of 30-60 minutes before transferring it to your hospital tank. Include a hitching post of some sort in the container and follow these instructions: place the fish in a three-gallon bucket or a similar clean, inert container containing precisely one gallon of siphoned, aerated tank water. Medicate the bucket of water with with the appropriate amount of formalin for a concentrated bath according to the directions on the label. Place an airstone in the bucket and leave the fish in the bath for 30 minutes. If at any time the fish becomes listless, exhausted or loses its balance, immediately place the fish in clean, untreated water in your hospital tank.

I want you to be aware of these precautions when administering the formalin bath:
Formalin has limited shelf life and degrades to the highly toxic substance paraformaldehyde (identified as a white precipitate on the bottom of the solution); avoid using any formalin product which has such a precipitate at the bottom of the bottle.
Formalin basically consumes oxygen so vigorous aeration must be provided during treatment.
Time the bath closely and never exceed one hour of chemical exposure at this concentration.
Observe the seahorse closely during the bath at all times, and it show signs of distress before the allotted time has elapsed, remove it from the treatment immediately.

If you can obtain Formalin 3 from Kordon at your LFS, Ken, these are the instructions you should follow for your formalin dip:

METHOD 2 (DIP) FOR THE PREVENTION OR TREATMENT OF FISH DISEASES
(a) To a clean, non-metallic container (i.e., a plastic bucket), add one or more gallons of fresh tap water treated with Kordon’s AmQuel . For marine fish use freshly prepared saltwater adjusted to the same specific gravity (or salinity) as in the original tank. Make sure the temperature in the container is identical to that in the aquarium
(b) Add 1 teaspoons of Formalin·3. This produces a concentration of 100 ppm. formaldehyde.
(c) Agitate the solution with an airstone and adjust for a moderately strong flow of air.
(d) Remove the fishes to be treated and deposit them in the container for a treatment period of not more than 50 minutes. Immediately after the treatment period, or if signs of distress are noted, remove the fishes to a previously prepared recovery tank. The fishes may be returned to their original tank, but the presence of the original disease-causing agents in the tank water may result in a reoccurrence of the disease condition.
(e) Observe recovering fishes. Make sure that tankmates do not molest them during recovery.
(f) Repeat treatment as needed, every week. Each treatment is stressful to the treated fishes. Do not reuse the dip solution.

For additional information on treating fishes with Formalin 3 by Kordon, see the following web page:

Click here: KPD-54 Formalin-3
http://www.novalek.com/kpd54.htm

If you get another brand of formalin, just follow the instructions that it comes with for a concentrated bath or dip (not prolonged immersion or a long-term bath) or follow the following directions, courtesy of Ann at the org:

FORMALIN Short-Term BATH Dosage and Preparation Instructions
Active Ingredient: 37% Formaldehyde
Indication: external parasites
Brand Names: Formalin, Formalin-MS
Notes:
1. Do NOT use Formalin that has a white residue at the bottom of the bottle. White residue
indicates the presence of Paraformaldehyde which is very toxic.
2. "Formalin 3" by Kordon contains only 3% Formaldehyde. Dosing instructions will need to be modified if using this product.
• Fill a small tank with aged, aerated, dechlorinated marine water. Match the pH, temperature, and salinity to that of the tank the Seahorse is currently in.
• Add an artifical hitch and 1-2 vigorously bubbling airlines. Formalin reduces dissolved O2 so heavy aeration is required.
• Add 1ml/cc of Formalin per one gallon (3.8 liters) of tank water. Allow several minutes for the Formalin to disperse.
• Place the Seahorse into the dip water for 45-60 minutes unless it is showing signs of an adverse reaction. If the Seahorse cannot tolerate the Formalin dip, immediately move it back to the hospital tank.
• Observe the Seahorse for 24hrs for signs of improvement.

In short, Ken, isolate the affected seahorse ASAP, treat it with antibiotics, and administer a series of three formalin baths over the space of one week (perform the first formalin bath before you transfer the seahorses to the treatment tank). (In stubborn cases, the formalin baths may need to be administered daily.) Gradually reduce the water temp in the treatment tank and keep offering the enriched live adult brine shrimp to tempt the seahorse to eat.

Best of luck resolving this skin infection, sir.

Respectfully,
Pete Giwojna

Post edited by: Pete Giwojna, at: 2010/05/10 03:30