FAQs on Freshwater Head & Lateral Line Disease, HLLE, HITH (Hole In The Head)... 2 Related Articles: Head and Lateral Line Disease (HLLE), Freshwater Diseases, FW Disease Troubleshooting, Ich/White Spot Disease, Freshwater Medications,  Related FAQs:  Freshwater HLLE 1, & FAQs on FW HLLE: Causes/Etiology, Cures, Non-Cures, FW Case Histories, SW Case Histories, & Marine HLLE: HLLE 1, HLLE 2, HLLE 3,Nutritional Disease, Aquarium Maintenance, Freshwater Medications, Freshwater Infectious Disease, Freshwater Fish Parasites, Ich/White Spot Disease, African Cichlid Disease 1, Cichlid Disease,

Help with sick Severum Severum Starting To get Hole-In-The-Head 9/9/08 Hi, I have a 200 litre aquarium which has 5 angels, 1 Oscar, 1 silver shark, 1 bichir, and a breeding pair of Severums. All fish are totally fine expect for the Severum which has been getting strange white bumps around his eyes and on his head for the last few days. I have attached a picture, I wonder if you could advise what is wrong with my fish and how to treat it?? Many thanks Jason Ingold < It looks like you Severum is showing the first signs of Hole-In-The-Head disease. After the pus filled blisters pop a hole is left in its place. The holes continue to grow eating away the skull. There are some ideas to what the cause of this disease could be but no exact pathogen has been identified. The stress of breeding could have weakened your fish and made them vulnerable. If it was my fish I would place it in a hospital tank with clean warm(82 F) water. Treat the tank with Metronidazole and Nitrofuranace. If the fish is still eating then feed a medicated food with Metronidazole in it. Generally I would try to improve the diet with a quality pellet food. If you fish is still eating I would try a little trick I stumbled on a few years ago. I had an south American cichlid like yours that just started to get the disease but was still eating. He especially love black worms. I took the portion of black worms in a little plastic cup with some water and medicated the worms with the dosage of Metronidazole. The worms died right away and I quickly fed them to my fish. The fish were unaware that the worms were dead and ate them all up. The lesions turned black the next day. I did a major water change, cleaned my filters and got some fresh fish food that was high in vegetable matter. I felt that this would provide the minerals my fish may have been missing. Hope this helps.-Chuck>

Cichlid problem, hlth.   8/17/08
Hello again,
My T-bar cichlid has got hole in the head, all my fish are scratching, twitching and have all there fins down.
<Likely caused by Hexamita, and almost always trigger by environmental or dietary deficiencies, i.e., overcrowding, high nitrates, lack of fresh greens. Treatment is only possible via Metronidazole, couple with correction of water quality/diet.
http://www.wetwebmedia.com/metranidazole.htm
>
They are all eating normally except my T-bar with hole in the head and they have been doing this for 3 days now and they have no signs of any spots so it cant be white spot.
<Hexamita is most common when cichlids are overcrowded. Quite possibly latent in all cichlids, when their immune system becomes weakened the Protozoans spread from the digestive tract into the body and out to the lateral line. It's the ones in the lateral line that cause the distinctive pits and lesions.>
What could be wrong with them all?
Thanks
<Review environment, diet, and act accordingly. Cheers, Neale.>

Re: cichlid problem  08/18/2008
Hello,
When you said "review environment" what did you mean? My tank has lots of bogwood and a few plants with fine gravel.
Thanks.
<Simple. Take a look at all the requirements for the fish you have. Look in an aquarium book (or search this web site) to find out more about each species. Note things like water chemistry (pH, hardness), diet, space requirements, compatibility with other fish, etc. Write all these things down. Then compare them to the environment in your aquarium. Any differences between what your fish need and what you are providing will be likely sources of potential problems. Also check nitrite and nitrate; nitrite should be zero at all times, and with cichlids nitrate should be as low as practical, ideally less than 20 mg/l. Cheers, Neale.>
 

What type of filter media should I use? (RMF, comments on Hexamita, carbon?)  7/13/08 I have been searching for many answers in your forum for the past few days, and I must say "thank you" for all of this information. I have answered most of my questions using the search. To explain myself, I would like to give a little background. <Ok.> A friend of mine moved out of the area and asked me to take his aquarium. There is one very large Oscar in a 35 gallon Hex aquarium with an Marineland Emperor 280 power filter. <Ah, first problem: the tank is _way_ too small for an Oscar, arguably even for a juvenile, let alone an adult. A tank twice this size would be much more reasonable. All cichlids are sensitive to dissolved metabolites -- that means ammonia, nitrite, and nitrate. So you need both good filtration (to deal with the nitrite and ammonia) and aquarium capacity to dilute the nitrate. Water changes of 25-50% per week are needed to further dilute the nitrate. Without this sort of regimen, cichlids are extremely prone to disease, especially Hexamita and Hole-in-the Head.> The Oscar started getting HITH disease even though I do weekly water changes and according to my LFS, all tests show very good water quality for this type of fish. <There you go. Am I good or what? The point here is that the tank is too small. While it is (theoretically) possible to keep cichlids in small tanks by doing massive (e.g., 90%) water changes on a daily basis, the only practical way to keep them as low-maintenance pets is to use a big tank so that water changes can be spaced out.> I read on your pages about Oscars that HITH may be caused by stress from the aquarium being too small, as well as the use of carbon. <Both these things have been cited in the past as possible triggers. But the balance of opinion nowadays relates HITH to the protozoan Hexamita, an organism that probably lives harmlessly enough in the digestive tracts of many aquarium fish, including cichlids. But when conditions decline, e.g., nitrate exceeds 20 mg/l, the fish's immune system stops working properly and the Protozoans can spread, causing harm. The precise symptoms depends on where the Protozoans end up, which is why Hexamita and HITH had been considered separate diseases for a long time. Both diseases fall under the category of "easy to prevent, difficult to cure".> My friend, and now myself, has always used Marineland Diamond Blend Filter Media in the Emperor 280's media basket…which is carbon and ammonia remover combined. <Not a huge fan of chemical media, either carbon or zeolite, in freshwater tanks. Neither serves much purpose when compared with the much bigger benefits obtained by doing large (50% weekly) water changes instead. Zeolite is doing something your filter bacteria is doing anyway, so is utterly redundant except in tanks (e.g., hospital tanks, sub-pH6 tanks) where it isn't possible to use biological filtration. In the past the theory was carbon removed dissolved organics from the water, letting you minimise water changes. When I started in the hobby, "old water" was recommended for freshwater fish, with aquarium books often suggesting 10-25% water changes a month as reasonable. Over time the dissolved organics made the water more acidic and gave it a yellow colour. If you do big, weekly water changes, none of this happens, so the carbon is redundant. Furthermore, to actually work properly, carbon needs to be replaced at least monthly, something hardly anyone in freshwater fishkeeping does. So all you get is carbon behaving as an (admittedly reasonably good) substrate for filter bacteria. Instead I would recommend using exclusively top-notch biological such as Siporax together with mechanical filter media that can be cleaned/replaced according to your budget. You should also have a filter offering not less than 6 times (and ideally 10 times) the volume of the tank in turnover per hour (irrespective of the "recommended aquarium" size offered by the manufacturer of said filter, as these assume best-case scenarios of tanks with small, clean fish like Neons).> I purchased a 75 gallon aquarium, and an additional Emperor 280 power filter. I plan to use both of the 280 filters on the 75 gallon. <These filters offer filtration of 280 gallons per hour each, and for your tank I'd recommend at least 450 gallons per hour total and ideally up to 750 gallons per hour. With big, messy fish -- the more the better. I am not wild about hang-on-the-back filters though because they don't seem to be as flexible as canister filters. I want filters that can have the inlet and outlet put where I want them, not limited by the design. I don't like filters that use proprietary "modules" either -- I want to be able to put whatever media I want in the filter. Hence I'd always recommend a decent canister filter such as the excellent value and highly reliable Eheim 2217. At about 260 gallons per hour, two of these would provide adequate filtration and three would provide excellent filtration. They are basically empty buckets into which you cram in whatever media you want. For an Oscar, a mix of sponges/filter wool for solid waste and then lots of ceramic noodles for biological filtration would be ideal. Eheim filters may be slightly more expensive than generic Chinese brands, but they last forever (or at least 10+ years) and such spare parts as you might need (like the rubber seals that will wear out after a while) are cheap and easy to obtain.> From the reading on your site, I have used water from the old aquarium in the new aquarium. <Makes absolutely no difference. The bacteria are not in the water column or even sitting on the gravel (much) but in the filter media. Unplug a mature filter from one tank and connect it to another tank with similar water chemistry, and you it will carry on working perfectly. You can also donate 50% of the media from a mature filter to a new filter to instantly cycle the new filter without causing any harm to the mature filter.> I also placed the new filter on the old aquarium in order to ready the new filter's bio-wheel. Since you do not recommend carbon in a freshwater aquarium, and this could be causing the HITH disease, what would you recommend I use in the filter media baskets? <As stated above.> Also, the Marineland "Rite-Size E" filter cartridges come packed with activated carbon. Should I slice these open and remove the carbon? <Nope. Just consider them money down the drain. Or at least that's how I view them. Activated carbon is a posh way of saying "charcoal", and a great way for manufacturers to sell you something at a premium that costs very little to make. These "filter cartridges" are overpriced for what they are anyway, and that just adds insult to injury. Over the long term, a plain vanilla canister filter into which you can add whatever media you choose will work out so much cheaper, as well as working MUCH MUCH better.> Thank you for all your help, Jay <Cheers, Neale.> <<I am in agreement. RMF>> Re: What type of filter media should I use?  - 07/13/08 I understand what you are saying about filtration, but given my budget and what I have already spent, do you think the two Emperor 280's hanging on the back plus one Eheim 2217 (as you suggested as a good canister) would suffice for this 75 gallon with the one large Oscar? The 280s come with empty media chambers and I will pick up Siporax as you suggested to fill these with. The Eheim is 260gph and the two Emperor filters are 280 each. This would bring my turnover to approx 820gph (manufacturer spec). Thanks again, Jay <Hello Jay. What you propose should work. But you'd want to be clever about where you positioned all these filters to that they weren't all pumping water around just one end of the tank. With big aquaria, it's important to make sure the bottom of the tank receives lots of water current. So perhaps you'd arrange the Eheim so the spray bar pushes water downwards rather than forwards. Even better (and not expensively) you could couple the canister filter with an undergravel filter plate to create a "reverse flow undergravel" filter. This works by the filter pushing water into the filter plate via what would ordinarily be the uplift. The water then comes upwards through the gravel, further supporting nitrifying bacteria and incidentally also keep the gravel much cleaner than otherwise. While not much used nowadays, undergravel filters work amazingly well, and provide good water quality at low cost. A 75-gallon tank should work nicely for an Oscar (or a mated pair). Cheers, Neale.> Re: What type of filter media should I use?  - 07/13/08 Thank you for the quick responses and for the great information. I would have never thought about using an undergravel filter to create uplift. <Used to be very common during the 1980s, and much appreciated in tanks such as Mbuna systems where you want to combine good biological filtration with the chemical buffering provided by a calcareous substrate. Out of fashion nowadays because undergravels generally don't work with plants, and that's the direction advanced freshwater hobbyists tend to go.> The Emperor 280 filter's water intake tubes have a dual intake. I will have one at each end of the 75g aquarium, so water will be pulled into the filter from the bottom and middle of the tank and at both ends. Should I position the Eheim pickup in the middle of the aquarium near the water surface? <Without seeing these filters _in situ_ it's difficult to make any pronouncements here! But here's my test. Put individual flakes of food in the aquarium at different positions and depths. Watch the flakes drift around. If they move about constantly wherever you put the flake, then you're fine. If they collect in certain corners, then you have a "dead patch". If you find the flakes drift slower at some points than others, you have inconsistent water flow. In either case, review the position of the inlets/outlets and try again. As always, theory is fine, but actual experimentation is better!> Maybe even build a skimmer box that the Eheim pickup could pull water from in order to clean the water surface?? <Largely a waste in non-planted tanks. Surface skimmers are great for removing bits of leaves and such that float about. In non-planted tanks this isn't an issue. Rather, your problem is going to be faeces and uneaten food collecting on the substrate. Water changes will help (stir the gravel a bit each time) but my "tip of the day" is to buy a turkey baster. These are great for spot-cleaning waste in large tanks. Cheap and very effective. Also very useful for catching fry and separating eggs from mouthbrooding fish. No aquarist should be without one!> Your expertise is greatly appreciated. Thank you, Jay <Cheers, Neale.>

My Frontosa, HLLE tissue damage  - 7/1/08 Hi, I wrote you before about my Front, Georgie and his hole-in-the-head problem, and that I treated him with Medizole and Furnace, I then noticed it looked like fungus so I treated him again with just the Furnace, It looked like it went away but his holes didn't look any better, so I then treated him with some medication called Hole-in-the-Head by JUNGLE, and he still looks like this, is there any hope? <To heal the wounds from the neuromast destruction? Mmm, yes... with time, good nutrition, water quality...> ( I sent you a couple pics) I have had him for a long time( we think he is around thirteen years) and he has always been healthy but know I am at a loss, usually when I treat my fish I have good luck if I catch it right away, I am sending you a few pics and see if you can see what you think, Thank you for your time, John Cline <Have seen worse cases remit. Do try feeding Spectrum pellets exclusively, being religious re weekly water changes... Read here: http://wetwebmedia.com/hllefaqs3.htm and the linked FAQs files in this series above. Bob Fenner>

POSSIBLE DISEASED GOURAMIS, HLLE  – 06/28/08
Hi Team,
I currently have a 35 gallon tropical tank, PH 7.2, Ammonia = 0, Nitrite = 0, Nitrates = 10-20. I have 2 Pearl Gouramis, 1 male and one female and both have small holes around the top half of their head around the eyes and 'nose'. They are not filled with puss etc. They are empty like bore holes.
<Sounds like Head & Lateral Line Erosion disease (HLLE), a syndrome that may, or may not, be related to the Hexamita parasite. I would treat for Hexamita anyway, and also review water chemistry/quality.>
The male is a much paler colour than normal.
<Again, consistent with HLLE/Hexamita.>
The female still looks a normal colour. The holes are only on the Gouramis. All other fish seem unaffected (1 queen arabesque Pleco, 1 Betta, 9 neon tetras, 1 swordtail).
<Hexamita/HLLE doesn't affect all fish species equally strongly. Cichlids are by far the most prone, but Gouramis can develop the symptoms too. I've never heard of Catfish, Livebearers or Characins developing the disease. This isn't to say they don't, but it isn't common.>
I feed them on Tetra Pro flake food/varied sinking pellets and a weekly treat of frozen daphnia or brine shrimp. I would guess that this is hole in the head disease from the info on your site but I change 10-20% water weekly and feed high quality and varied food so I am not sure how this would have happened as this often relates to poor water.
<Indeed this is the case. But the infection can be latent in store-bought fish, only to develop a few weeks or months after purchase. Inbreeding may weaken the immune system of some fish species. Nitrate is likely the triggering factor with cichlids, but 20 mg/l nitrate is "safe", so not really sure what's going on here. Regardless, treat first, worry about the science later.>
Is hole in the head disease infectious??
<Not really, no; Hexamita quite probably sits inside the guts of most fish harmlessly, and only causes problems when their immune systems are otherwise impaired. If it is in your system, then all fish have been exposed, so isolating any one fish won't make a huge difference. Since only certain fish develop the disease (or diseases) there isn't any need to worry about the catfish, tetras, or livebearers. By all means isolate the fish if it makes treatment easier/cheaper, but beyond that there's no overbearing reason to do so.>
Are my other fish likely to catch it from the Gouramis??
<Possibly the Betta.>
Are there any treatments available in the UK that you could recommend??
<Yes. eSHa make something specific for Hexamita/Discus Disease. Not used it myself, but I rate their other medications very highly.
http://www.eshalabs.com/hexamita.htm
>
Or is it maybe too late to save them??
<Fish can, do recover from Hexamita provided they are treated and properly fed/maintained.>
I would like to treat the entire tank anyway if poss. as a precaution.
Thanks
Brian
<Cheers, Neale.>

Hole in the head
Hi from Australia,
I have a problem with my tropical tank so first some background info (sorry, this could take a while); It's a 55gal and has been up and running for about 3 months with an Eheim 2229 wet/dry, It has been on 0 nitrites, nitrates and ammonia all the time (had LFS double check this), the ph has been 7 constantly. The tank is well planted and the plants are healthy and growing well (I used undergravel plant tablets for them).
I introduced my fish slowly first 8 Neons, one week later 4 dwarf Gourami, 2 weeks later 3 small bristlenose, 1 week later a small angelfish and a pearl Gourami all the time maintaining zero levels of everything.
<This all sounds very good>
First one of my dwarf gouramis got bloat and died, research done so more varied diet (peas, flake food, mosquito larvae.) introduced and reduced amount of feeding. By the way weekly water changes of 1/4 have been going on since 3 weeks in.
<This is probably a bit much on the water changes. If you want to do them weekly cut them back to about 10% unless you notice your levels start to rise.>
Then introduced Siamese fighter, (2 weeks later) left the tank in fathers care for 3 days when I returned it was hanging on the surface and looked like its fins were all stuck together, it refused to eat and consequently died and when I took it out I noticed blood oozing from its fins (the fish was a red colour so I didn't notice earlier) there was no evidence of damage to the fins though, up until then it had been very happy in the tank exploring and eating fine (Betta bits+mosquito larvae).
<Sounds like he might have died of septicemia. Info here: http://www.wetwebmedia.com/FWSubWebIndex/fwfshparasites.htm >
Now to the current problem, one of my other dwarf gouramis has hole in the head, the LFS had given me tablets to treat the previous bloat problem and they said this is also for HITH, I can't remember their name but they were large white tablets, sorry I'm sure that doesn't help much.
<Unfortunately, I don’t know what the tablets would be. Possibly Maracyn but there are others that look similar. And without knowing what they are I can’t tell you much about their use.>
I put 15L water from the tank into a bucket with some plants and a heater I worked out the tablet dosage as 1 per 25L as they had told me to put 10 in my 240L tank for the bloat so I put 1/2 a tablet dissolved in the bucket and left the fish in their overnight by morning it was swimming erratically and blowing bubbles at the surface, I immediately moved it to the old tank and it is almost back to normal now. Does it look like I could have overdosed the fish? The dosage for the bloat in the 240L (55gal) was 10 tablets every day for 3 days than a 50% water change.
<You said you put in plants and a heater but did you put in an airstone or pump or anything? If not, this is probably what was making the fish go crazy instead of the medication.>
What is happening to my fish? My LFS has no idea they say HITH and bloat are often caused by stress but with few fish, many plants and excellent water conditions I doubt it. The gouramis do occasionally chase each other but not excessively. The fish are neither fat nor thin so I must be feeding the right amount of food.
<Most diseases can be brought on by stress but that’s not always the cause. And even just the introduction of a new fish can cause stress. Imagine you live alone in a 4 bedroom house. Someone you don’t know moves into the house with you. You still have plenty of room, the air is still good, you have plenty to eat, but you’re still nervous right? It’s the same thing for your fish. So this could have been triggered by stress even though their conditions are excellent.>
Could there be any other problems with my water? I use 1/2 rainwater, (very alkaline) and 1/2 bore water (very acidic). Are there any other tests I could carry out?
<This should be fine as long as you are acclimating all of the fish to it slowly.>
The only thing I know I have done wrong is not having a quarantine tank so I went out and bought one yesterday and I will not introduce any more fish without quarantining them first.  
<Good. I would isolate the guy with the HITH and medicate him in that tank. Don’t put him back in your main tank until you know he’s completely well again.>
Sorry for the long e-mail but I'm at my wits end I have told this story to 3 different LFS and none of them have a clue what is happening. Thanks Emma
<Well, I hope I was of some help! Ronni>