An infection will usually first manifest in fish by causing frayed and ragged fins. This is followed by the appearance of ulcerations on the skin, and subsequent epidermal loss, identifiable as white or cloudy, fungus-like patches – particularly on the gill filaments. Mucus often also accumulates on the gills, head and dorsal regions. Gills will change colour, either becoming light or dark brown, and may also manifest necrosis. Fish will breathe rapidly and laboriously as a sign of gill damage. Anorexia and lethargy are common, as are mortalities, especially in young fish.

Columnaris (also referred to as cottonmouth) is a symptom of disease in fish which results from an infection caused by the Gram-negative, aerobic, rod-shaped bacterium "Flavobacterium columnare". It was previously known as "Bacillus columnaris, Chondrococcus columnaris, Cytophaga columnaris" and "Flexibacter columnaris". The bacteria are ubiquitous in fresh water, and cultured fish reared in ponds or raceways are the primary concern – with disease most prevalent in air temperatures above 12–14 °C. It is often mistaken for a fungal infection. The disease is highly contagious and the outcome is often fatal. It is not zoonotic.

Diseases can have a variety of causes, including bacterial infections from an external source such as "Pseudomonas fluorescens" (causing fin rot and fish dropsy), fungal infections (Saprolegnia), mould infections (Oomycete and "Saprolegnia"), parasitic disorders ("Gyrodactylus salaris", "Ichthyophthirius multifiliis", Cryptocaryon, Oodinium causing velvet disease, "Brooklynella hostilis", head and lateral line erosion, Glugea, "Ceratomyxa shasta", "Kudoa thyrsites", "Tetracapsuloides bryosalmonae", "Ceratomyxa shasta" leeches, nematode, Trematoda, Platyhelminthes and fish louse), viral disorders, metabolic disorders, inappropriate water conditions (insufficient aeration, pH, water hardness, temperature and ammonia poisoning) and malnutrition.

External bacterial infections may cause spots or streaks on the body which appear red or orange Dropsy (bloating) is also a sign of a bacterial infection. "False fungal infections" look like fungus but is actually a bacterial infection known as Columnaris. These symptoms may include a white or gray film on the body.

Ornamental fish kept in aquariums are susceptible to numerous diseases. Due to their generally small size and the low cost of replacing diseased or dead fish, the cost of testing and treating diseases is often seen as more trouble than the value of the fish.

Due to the artificially limited volume of water and high concentration of fish in most aquarium tanks, communicable diseases often affect most or all fish in a tank. An improper nitrogen cycle, inappropriate aquarium plants and potentially harmful freshwater invertebrates can directly harm or add to the stresses on ornamental fish in a tank. Despite this, many diseases in captive fish can be avoided or prevented through proper water conditions and a well-adjusted ecosystem within the tank.