Angelfish with sunken in head

reefknot · Nov 21, 2020

Help! My angel fish has developed a sunken/hollowed head in the last week. When i first noticed it (5 days ago), it was barely noticeable but has gotten worse in the last few days. I have googled this to no end and the only thing that has come up is hexamita (hole in the head) which i don't think is what it is, as it doesn't look like the pictures of hexamita and there are no white spot/pimples that i can see which seems to be the early signs of it. It's only affected this one angelfish, and it seems healthy otherwise, eating well, and pooing fine from what i've seen.

In the tank, i have 2 angelfish and 4 cherry barbs and its a 35gal tank, (+ a few nerite snails and countless trumpet snails) I feed them a variety of different foods (pellet food, dried bloodworms and occasionally dried daphnia) do approx 30-50% water changes every two weeks, there haven't been any new additions to the tank for two years (fish, plants or otherwise). I did a water parameter check as soon as I noticed this angelfish's head looked weird and it came up as everything in the range it should be and did another just now (4 days after last water change) and everything was as i wrote below

I asked in a few of my fish groups on facebook but no one really had any certain answers. One person said it is hole in the head, another said a birth defect, one said looks like fish TB.

Symptoms: Sunken/hollowed head just above the eyes, that started on one side, has gotten worse/more noticeable and is also on the other side now too. No spots, no wounds, nothing else that i can tell. Is eating fine, is still active and swims around with my other angelfish
Tank size: 35 imperial gallons
tank age: about 3 and a half years
pH: about 6.8/7
ammonia: 0 ppm
nitrite: 0 ppm
nitrate: 0 ppm
kH: unknown
gH: unknown
tank temp: 25 celcius
Also feel important to note i had activated carbon in my filter since i've had the tank,but took it all out a few days ago after reading about hexamita as i thought thats what my fish had until i read better descriptions/saw photos of it

It's hard to get a photo but i've attached some below, the white one is the one with the weird head. The black one is fine

Utar · Nov 21, 2020

I am so sorry about this but I have no idea what is wrong with your Angel Fish. I tried looking this up to so I could help you but found nothing on this. The only thing I see wrong is 0 nitrates. In a fully cycled tank one should see some nitrates. How long as you tank been up and running?

Someone will be along that can help you I am sure.

Naughts · Nov 21, 2020

@Lajos_Detari can you help?!

Colin_T · Nov 21, 2020

Utar said:
I am so sorry about this but I have no idea what is wrong with your Angel Fish. I tried looking this up to so I could help you but found nothing on this. The only thing I see wrong is 0 nitrates. In a fully cycled tank one should see some nitrates. How long as you tank been up and running?.

You can have established tanks with 0 nitrates. If the tank has lots of plants and only a few fish, the plants will use any ammonia as soon as it's produced and there won't be any nitrates. They might have done a big water change before testing and that lowered the nitrates.

----------------------------------------
For the OP.
This is not fish Tuberculosis (TB). Fish TB would not affect that part of the body and the only way TB could affect that area, was if the fish had damaged the area on the head and there was TB cells in the tank. If a TB cell got into an open wound on the fish's head, then it could become an infection and turn into an ulcerated sore over a period of several months. There is no sore and the sunken bit is on both sides so TB is not the issue.

This is not Hole in the Head/ Head and Lateral Line disease either. That causes small white bumps to appear (these look like little pimples). After a few days they pop and it looks like small white worms coming out of the fish. The white bits appear around the head and lateral line on the fish. Your fish has nothing like this.

This is not a birth defect. A genetic problem/ birth defect would have been visible on a young fish when you got it from the shop and would not appear on an adult fish.

--------------------
The area in question is normally fatty tissue and regularly becomes enlarged when the cichlids are well fed. Male cichlids in particular develop a larger area here when well fed. Your black marble angelfish is a male and it has a well pronounced, rounded fatty tissue deposit on it head. The fatty tissue shows female cichlids that the male eats well and is potentially a good partner. It also provides the male with some energy reserves if/ when he is defending a territory and guarding a nest or babies.

--------------------
The only time I have seen fish sunken in around the head like this is when they are starving. They basically waste away over a period of months and any muscle and fat in this area gets used up and the fish develops the sunken in appearance likes yours. However, this normally takes months and does not happen in 5 days.

The fact this happened quickly would suggest a disease organism but I have no idea what it is. You say the fish is eating normally, and its poop appears normal.
What colour is the fish's poop?

If its poop is coloured and normal it's not an issue, but if the poop is white or stringy, it could be an internal protozoan infection. However, I don't know why it would be sucking the fat out of the fish's head.

Joke time (Was your fish abducted by aliens who sucked its brain out, or has your fish had liposuction lately?)

--------------------
You could try feeding it more often and use frozen (but defrosted) foods and live foods. Raw/ cooked prawn/ shrimp is a good food to help most fish build up fat reserves. Fish, squid, bloodworms, brineshrimp, etc are also useful. Feed the fish 3-5 times per day and see if it helps. You will have to do big water changes and gravel clean the substrate every couple of days to keep the nutrients down while feeding more often.
Make sure any new water is free of chlorine/ chloramine before it's added to the tank.

*NB* if you have live shrimp in the tank, use cooked prawn only because raw prawn can spread diseases to the shrimp in the tank.

The only other things I could suggest would be to deworm the fish and try Metronidazole. You live in the UK and Metronidazole might not be available because it is an anti-biotic used to treat intestinal protozoan and bacterial infections in people. If you can get Metronidazole, then I would use it in a separate bare tank if possible. If you want to deworm the fish, see directions below.

----------------------------------------
BEFORE TREATING
Before you treat the tank with anything, do the following things.
Work out the volume of water in the tank:
measure length x width x height in cm.
divide by 1000.
= volume in litres.

If you have big rocks or driftwood in the tank, remove these so you get a more accurate water volume.

When you measure the height, measure from the top of the substrate to the top of the water level.

You can use a permanent marker to draw a line on the tank at the water level and put down how many litres are in the tank at that level.

There is a calculator/ converter in the "FishForum.net Calculator" under "Useful Links" at the bottom of this page that will let you convert litres to gallons if you need it.

Remove carbon from the filter before treating or it will adsorb the medication and stop it working.

Wipe the inside of the glass down with a clean fish sponge.

Do a 75% water change and gravel clean the substrate. The water changes and gravel cleaning will reduce the number of disease organisms in the water and provide a cleaner environment for the fish to recover in.
Make sure any new water is free of chlorine/ chloramine before it is added to the tank.

Clean the filter if it hasn't been done in the last 2 weeks. Wash the filter materials/ media in a bucket of tank water and re-use them. Tip the bucket of dirty water on the garden/ lawn.

Increase surface turbulence/ aeration when using salt or medications because they reduce the dissolved oxygen in the water.

----------------------------------------
DEWORMING FISH
You can use Praziquantel to treat tapeworm and gill flukes. And Levamisole to treat thread/ round worms. If you can't find these medications, look for Flubendazole, which treats both lots of worms.

In the UK look for:
eSHa gdex contains praziquantel that treats tapeworm and gill flukes.
eSHa-ndx contains levamisole and treats thread/ round worms.
NT Labs Anti-fluke and Wormer contains flubendazole.
Kusuri wormer plus (contains flubendazole) - sold mainly for discus, comes as a powder which is quite hard to dose in smaller tanks
Sera nematol (contains emamectin)

Remove carbon from filters before treatment and increase aeration/ surface turbulence to maximise oxygen levels in the water.

You treat the fish once a week for 4 weeks. The first treatment will kill any worms in the fish. The second, third and forth treatments kill any baby worms that hatch from eggs inside the fish's digestive tract.

Treat every fish tank in the house at the same time to prevent cross contamination.

You do a 75% water change and complete gravel clean 24-48 hours after treatment. Clean the filter 24-48 hours after treatment too.

Do not use the 2 medications together. If you want to treat both medications in a short space of time, use Praziquantel on day one. Do a 75% water change and gravel clean the substrate on day 2 & 3. Treat the tank with Levamisole on day 4 and do a 75% water change and gravel clean on day 5, 6 & 7 and then start with Praziquantel again on day 8.

The water changes will remove most of the medication so you don't overdose the fish the next time you treat them. The gravel cleaning will suck out any worms and eggs that have been expelled by the fish. Repeating the treatment for 3-4 doses at weekly intervals will kill any worms that hatch from eggs.

reefknot · Nov 22, 2020

Utar said:
I am so sorry about this but I have no idea what is wrong with your Angel Fish. I tried looking this up to so I could help you but found nothing on this. The only thing I see wrong is 0 nitrates. In a fully cycled tank one should see some nitrates. How long as you tank been up and running?

Someone will be along that can help you I am sure.

I did a hasty and overzealous water change a few days ago haha, which is probably the cause of no nitrates, although i have always had fairly low levels of nitrates which i believe is due to the many plants in the tank, you cant see them so well in the photos but i have a lot of java moss, a couple of amazon swords, one is huge one is fairly small and a lot of java fern on one of my driftwoods

reefknot · Nov 22, 2020

WOW thank you so much for all this information, I appreciate it immensely.

The last time I saw the fish in question poo, was about 3 days ago and it seemed a normal brown colour, I haven't seen it poo since, but am keeping an eye out. It's still eating well, but I do only feed once sometimes twice a day, will up the feeding to see if this helps, and give them some shrimp.

I searched for Metronidazole but it seems to be illegal in the UK for treating fish, so maybe not! I'll look into getting some de wormer that you suggested, it doesn't hurt to try.

Thank you again for your help!

Colin_T said:
You can have established tanks with 0 nitrates. If the tank has lots of plants and only a few fish, the plants will use any ammonia as soon as it's produced and there won't be any nitrates. They might have done a big water change before testing and that lowered the nitrates.

----------------------------------------
For the OP.
This is not fish Tuberculosis (TB). Fish TB would not affect that part of the body and the only way TB could affect that area, was if the fish had damaged the area on the head and there was TB cells in the tank. If a TB cell got into an open wound on the fish's head, then it could become an infection and turn into an ulcerated sore over a period of several months. There is no sore and the sunken bit is on both sides so TB is not the issue.

This is not Hole in the Head/ Head and Lateral Line disease either. That causes small white bumps to appear (these look like little pimples). After a few days they pop and it looks like small white worms coming out of the fish. The white bits appear around the head and lateral line on the fish. Your fish has nothing like this.

This is not a birth defect. A genetic problem/ birth defect would have been visible on a young fish when you got it from the shop and would not appear on an adult fish.

--------------------
The area in question is normally fatty tissue and regularly becomes enlarged when the cichlids are well fed. Male cichlids in particular develop a larger area here when well fed. Your black marble angelfish is a male and it has a well pronounced, rounded fatty tissue deposit on it head. The fatty tissue shows female cichlids that the male eats well and is potentially a good partner. It also provides the male with some energy reserves if/ when he is defending a territory and guarding a nest or babies.

--------------------
The only time I have seen fish sunken in around the head like this is when they are starving. They basically waste away over a period of months and any muscle and fat in this area gets used up and the fish develops the sunken in appearance likes yours. However, this normally takes months and does not happen in 5 days.

The fact this happened quickly would suggest a disease organism but I have no idea what it is. You say the fish is eating normally, and its poop appears normal.
What colour is the fish's poop?

If its poop is coloured and normal it's not an issue, but if the poop is white or stringy, it could be an internal protozoan infection. However, I don't know why it would be sucking the fat out of the fish's head.

Joke time (Was your fish abducted by aliens who sucked its brain out, or has your fish had liposuction lately?)

--------------------
You could try feeding it more often and use frozen (but defrosted) foods and live foods. Raw/ cooked prawn/ shrimp is a good food to help most fish build up fat reserves. Fish, squid, bloodworms, brineshrimp, etc are also useful. Feed the fish 3-5 times per day and see if it helps. You will have to do big water changes and gravel clean the substrate every couple of days to keep the nutrients down while feeding more often.
Make sure any new water is free of chlorine/ chloramine before it's added to the tank.

*NB* if you have live shrimp in the tank, use cooked prawn only because raw prawn can spread diseases to the shrimp in the tank.

The only other things I could suggest would be to deworm the fish and try Metronidazole. You live in the UK and Metronidazole might not be available because it is an anti-biotic used to treat intestinal protozoan and bacterial infections in people. If you can get Metronidazole, then I would use it in a separate bare tank if possible. If you want to deworm the fish, see directions below.

----------------------------------------
BEFORE TREATING
Before you treat the tank with anything, do the following things.
Work out the volume of water in the tank:
measure length x width x height in cm.
divide by 1000.
= volume in litres.

If you have big rocks or driftwood in the tank, remove these so you get a more accurate water volume.

When you measure the height, measure from the top of the substrate to the top of the water level.

You can use a permanent marker to draw a line on the tank at the water level and put down how many litres are in the tank at that level.

There is a calculator/ converter in the "FishForum.net Calculator" under "Useful Links" at the bottom of this page that will let you convert litres to gallons if you need it.

Remove carbon from the filter before treating or it will adsorb the medication and stop it working.

Wipe the inside of the glass down with a clean fish sponge.

Do a 75% water change and gravel clean the substrate. The water changes and gravel cleaning will reduce the number of disease organisms in the water and provide a cleaner environment for the fish to recover in.
Make sure any new water is free of chlorine/ chloramine before it is added to the tank.

Clean the filter if it hasn't been done in the last 2 weeks. Wash the filter materials/ media in a bucket of tank water and re-use them. Tip the bucket of dirty water on the garden/ lawn.

Increase surface turbulence/ aeration when using salt or medications because they reduce the dissolved oxygen in the water.

----------------------------------------
DEWORMING FISH
You can use Praziquantel to treat tapeworm and gill flukes. And Levamisole to treat thread/ round worms. If you can't find these medications, look for Flubendazole, which treats both lots of worms.

In the UK look for:
eSHa gdex contains praziquantel that treats tapeworm and gill flukes.
eSHa-ndx contains levamisole and treats thread/ round worms.
NT Labs Anti-fluke and Wormer contains flubendazole.
Kusuri wormer plus (contains flubendazole) - sold mainly for discus, comes as a powder which is quite hard to dose in smaller tanks
Sera nematol (contains emamectin)

Remove carbon from filters before treatment and increase aeration/ surface turbulence to maximise oxygen levels in the water.

You treat the fish once a week for 4 weeks. The first treatment will kill any worms in the fish. The second, third and forth treatments kill any baby worms that hatch from eggs inside the fish's digestive tract.

Treat every fish tank in the house at the same time to prevent cross contamination.

You do a 75% water change and complete gravel clean 24-48 hours after treatment. Clean the filter 24-48 hours after treatment too.

Do not use the 2 medications together. If you want to treat both medications in a short space of time, use Praziquantel on day one. Do a 75% water change and gravel clean the substrate on day 2 & 3. Treat the tank with Levamisole on day 4 and do a 75% water change and gravel clean on day 5, 6 & 7 and then start with Praziquantel again on day 8.

The water changes will remove most of the medication so you don't overdose the fish the next time you treat them. The gravel cleaning will suck out any worms and eggs that have been expelled by the fish. Repeating the treatment for 3-4 doses at weekly intervals will kill any worms that hatch from eggs.

reefknot · Nov 24, 2020

Update:
the fish has not improved and it's head has been getting more and more hollowed each day, i have de wormer on the way, out of caution and i also hadn't witnessed the fish poo since a few days ago, but this morning i saw it and it was not white, or stringy, it seemed a normal fish poo

I've upped feeding, and have been feeding fresh, cooked prawns along side the usual pellet but feeding doesn't seem to have had any effect. I really don't know what else to do

Colin_T · Nov 25, 2020

Can you post some more pictures of the fish (side and front views), and a short video of them too?

You should document all of this because it might be something new to science.

You can try adding salt to the tank, (see directions below). It can help with protozoan infections, which this may or may not be. And look around for Metronidazole but I doubt you will find it in the UK without a vet, so you might have to get some online and see if it gets through customs/ postal services.

The only other thing it might be is something wrong with the fish's metabolism or some sort of immune system failure and the fish's body is destroying itself.

----------------------
SALT
You can add rock salt (often sold as aquarium salt), sea salt or swimming pool salt to the aquarium at the dose rate of 1 heaped tablespoon per 20 litres of water. If there is no improvement after 48 hours you can double that dose rate so there is 2 heaped tablespoons of salt per 20 litres.

If you only have livebearers (guppies, platies, swordtails, mollies), goldfish or rainbowfish in the tank you can double that dose rate, so you would add 2 heaped tablespoons per 20 litres and if there is no improvement after 48 hours, then increase it so there is a total of 4 heaped tablespoons of salt per 20 litres.

Keep the salt level like this for at least 2 weeks but no longer than 4 weeks otherwise kidney damage can occur. Kidney damage is more likely to occur in fish from soft water (tetras, Corydoras, angelfish, gouramis, loaches) that are exposed to high levels of salt for an extended period of time, and is not an issue with livebearers, rainbowfish or other salt tolerant species.

The salt will not affect the beneficial filter bacteria but the higher dose rate (4 heaped tablespoons per 20 litres) will affect some plants and some snails. The lower dose rate will not affect fish, plants, shrimp or snails.

After you use salt and the fish have recovered, you do a 10% water change each day for a week using only fresh water that has been dechlorinated. Then do a 20% water change each day for a week. Then you can do bigger water changes after that. This dilutes the salt out of the tank slowly so it doesn't harm the fish.

If you do water changes while using salt, you need to treat the new water with salt before adding it to the tank. This will keep the salt level stable in the tank and minimise stress on the fish.

Odd Duck · Nov 25, 2020

I have no idea if this applies, or not, but we see a similar appearance in dogs (and rarely in cats, ferrets, or a few other species) when they get an autoimmune disease of the masseter (chewing) muscles on top of the head. It is called masseter muscle myositis. The body attacks the muscle fibers of the chewing muscles for some reason and we almost never know what triggers it to occur.

This does NOT look like a skin infection to me since the skin appears normal and it looks like the tissue underneath the skin seems to have atrophied. Did you happen to notice any prominence of this area a few days before the sinking started? Or any reluctance to eat at that time? If so, that would fit exactly with what happens in dogs and cats. They first get swelling and pain of the area, then both start to fade and the muscles then atrophy away.

The rest of the fish doesn’t show signs of being skinny but I can’t see the rest well enough to be sure. I would also vote for a video of the fish in question.

Deworming might help if the fish is not getting proper nutrients due to parasites robbing them from the body. Ideal would be to collect a fecal sample and look for parasites under the microscope, then treat appropriately if any are found, but not many vets are willing to see/treat fish or even look for parasites this way for a fish.

There is a test in dogs for this syndrome, but not for any other species as far as I know.

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Angelfish with sunken in head

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