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TB in Fish, Mycobacterium Tuberculosis; Bettas & more


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

Betta with Fish Mycobacterium TuberculosisFish 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)


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)


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.

largemouth bass showing clinical signs consistent with mycobacteriosisThe 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.


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)
*Isoniazid (from Aquarium Medications Part 2)

Sometimes a Sulfamethazine/Trimethoprim Combination can be effective too.
*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.


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:

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:

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
*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 information for prevention of fish tuberculosis, TB
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!

*Aquarium UV Sterilization for prevention of fish tuberculosis, TB
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.

*Aquarium, Pond UV Lamps, Bulbs

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 with articles & commentary of Interest to the Aquarium Hobby

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


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In Chronological order of writing with the newest at the top

  1. How to Treat Sick Fish
  2. Whirling Disease in Fish
  3. Reef Aquarium Chemistry Maintenance
  4. Use of RO, DI, Softwater in Aquariums
  5. Lighting Theory of a Planted Aquarium- RQE, PFY, PAS, & PUR
  6. Aquarium or Pond Bio Load
  7. Tuberculosis in Fish
  8. PUR vs PAR in Aquarium Lighting
  9. Head Pressure in Aquarium and Pond Water Pumps
  10. Fin/Tail Rot For Betta & ALL Fish
  11. Angelfish Virus/Aids
  12. Activated Carbon
  13. Fish Baths/Dips as an aid to treatment
  14. Streptococcus gram positive bacterium in aquariums, Eye Infections
  15. Hydrogen Sulfide
    production in anaerobic De-Nitrification for Aquarium/Ponds
  16. Fish Shipping
  17. Aquarium Size, Fish Stunting
  18. Aquarium Algae,
    BBA & Brown Algae in particular
  19. Aquarium Salt (Sodium chloride) in Freshwater Aquariums
  20. Betta Habitat; Wild Bettas to Domestic Betta environment parameters
  21. HITH; Hole in the Head Disease
  22. Aquarium Protein Skimmers, Ozonizers
  23. Power Head/ Water Pump Review
  24. Molly Disease/ Mollies in an Aquarium
  25. Basic Fish Anatomy, Fin Identification
  26. Aquarium Moving/ Power Failures
  27. Octopus as Aquarium Pets
  28. Aquarium Nitrates
  29. Ichthyophonus protists, fungus in fish
  30. Aquarium and Pond Filter Media
    Types; Mechanical, Bio, Chemical
  31. Aquarium Water Conditioners (also Pond)
  32. Fish Parasites; Trematodes & Monogeneans; Annelids and Nematodes;
    Flukes, internal worms, Detritus Worms (often confused with Planaria), Micro Worms
  33. Aquarium Silicone Application;
    DIY Aquarium Repair & Glass thickness
  34. Pond Veggie Filters; DIY Bog Filter
  35. The difference between Plaster of Paris and Aquarium Products such a Wonder Shells:
    Identification, prevention & Treatment
  37. AQUARIUM TEST KITS; Use & Importance
  38. SEXING FISH; Basics
  39. Chocolate Chip, Knobby and Fromia Starfish
  40. Freshwater Velvet & Costia
  41. Usnic Acid as a Fish Remedy
  42. Aquarium Heaters; Types, information
  43. The Lateral Line in Fish, Lateral Line Disease
    or Head and Lateral Line Erosion (HLLE)
  44. Tap Water use in Aquarium; Chloramines, Chlorine
  45. Can Black Ghost Knife fish give an electric shock?
  46. Bio Wheel Review; Do Bio-Wheels really work?
  47. How do Fish Drink?
    Use of RO Water
  48. Cyclops, and Predatory Damselfly larvae
  49. Betta with Dropsy;
    Treatment and Prevention of DROPSY in all fish
  50. pH and KH problems in African Cichlid Aquarium
  51. Aquarium Gravel, which size?
  52. Blue green algae, Cyanobacteria in Ponds/Aquariums

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