In reading this, it is excellent. I especially liked the passage I am including at the bottom of the post. In modern infectious diseases in humans, the role in environmental stress is extremely important, can't imagine other organisms don't respond accordingly. Stress is caused by poor water, poor food, predation, territorial threats as well as other effects. If you grow up in a room full of tobacco smoke, you may well develop a disease, same with fish. We cannot test for all the toxins a aquarium can accumulate. Nor discount the stress a fish can encounter in a environment that doesn't suit them. It isn't a coincidence this condition targets surgeonfish as they are very broad ranging browsers that don't always accept confinement as well as other fish do.
Chronic Stress and Autoimmune Disease: This is probably one of this most interesting and novel ideas offered with regard to the causes of MHLLE. The basic premise is that fish held under certain conditions can be subjected to chronic stress and that due to this chronic stress, their immune system does not function properly (Bartelme, 2003a, b, c). This malfunction causes the body's own immune system to seek out and destroy healthy cells that it should otherwise be protecting. The author suggests a variety of ways this might occur, and I encourage all to read his works for further information. It simply would not be fair to try to sum up in a paragraph or two Mr. Bartelme's thoughts on this topic from his entire three part series of articles, so please follow up with my references (Bartelme, 2003a, b, c) below to read the complete and thorough explanation he offers. What I found most interesting about this theory is that it ties together most all of the other theories of MHLLE's causes (Note: there are at least a dozen other theorized causes. Just about anything and everything has been blamed at one time for causing this affliction.), groups them under the general category of stress, or as an opportunistic infection that thrives under stressful conditions, and then addresses what to do about this "disease complex." The practical application of these articles is in the recommendations Terry gives for combating this ailment. The first part of the treatment would be to eliminate or reduce any and all stress. This is broken down into four broad categories: extreme changes in the physical environment, animal interactions (such as predation, aggression and competition), poor water quality (low pH, high nitrate, heavy metals or dissolved organics) and human interference (such as overcrowding). The second step is to improve the diet as well as to add vitamin supplements and highly unsaturated fatty acids (HUFA's) to the fishes' food. Third, improve water quality via water changes and protein skimming while also limiting the use of activated carbon just in case it plays a role. And finally, he recommends enhancing the fishes' immune function by adding beta glucan and garlic extract to their food as immunostimulants.