You could try the Metronidazole, because as Kashta and Excuzzzeme have suggested this could be parasites. Metro is very mild and won't harm the bio-filter. I would try to mix some in with their food, as well, to try to get some inside them, too.
One other thing that seems a possibility to me, however, is mycobacteriosis, or fish TB, though you don't describe any of the characteristic physical changes that usually occur, other than emaciation.
I am copying and pasting a link to an article by
Diana Walstad who states that mycobacteriosis is the #1 cause of chronic illness in fish. The article is lengthy, but try to read it.
Here is the link to her article:
http://www.atlasbooks.com/marktplc/00388mycoarticle.pdf
A quick mention of a few of the points in that article that seem pertinent to me in this case:
1. The bacterium is present everywhere, it is frequently the cause of "mystery" illness in the aquarium, much more so than previously understood. Often, fish that are infected will have a variant that they may have some resistance to, but then when introduced to tank in which the occupants have never been exposed to this particular variant there will be an outbreak of illness.
2. If I remember correctly, (I haven't reviewed the article in quite some time), the illness may be slow and chronic, but also may progress rapidly without the usual physical signs, such as ulcers, redness of the skin, etc., and the fish may become emaciated in spite of eating well.
3. It is highly contagious.
Your Koi Angel is likely now exposed to a mycobacterium variant for which he has little or no resistance so he is at risk.
4. The use of a UV Sterilizer has been able to prevent disease outbreak in her tanks that have had previous outbreaks of mycobacteriosis, and, in her opinion, is the first line of defense in stopping the spread of the illness. It has prevented illness in fish that had been exposed.
If, once you read the article, you feel that this may possibly be the issue here, I would immediately get a UV sterilizer on the tank that your Koi Angel is in.
I am also providing a link to a thread here on AC in which this disease is discussed:
http://www.aquariacentral.com/forums/showthread.php?242837-Slow-die-off-has-consumed-nearly-20-fish!&highlight=mycobacteria
Regarding flushing the sick fish: I know you were probably just using an oft repeated phrase and would not ever want to do it, but I have to say it anyway - please don't flush a sick and dying fish; they die a slow death exposed to chemicals and crud in the sewer line.
Humane euthanasia is discussed in an excellent article by one of our AC members. I'm providing the link to that article for you. I think you will appreciate as much as I did when I read it, and I do use this method when I feel that a fish is suffering and his outlook is hopeless.
The article discusses using pure clove oil, (and some other methods), and gives detailed instructions on carrying this out in a very humane and gentle manner. The clove oil method is relatively low stress for the human, and can be extremely stress free for the fish, if carried out exactly as instructed.
Here is the link:
http://www.aquariacentral.com/forums/showthread.php?148361-Euthanasia
Having said all this about mycobacteriosis, I might be way out in left field here and this could be solely a case of internal parasites. You could proceed on that premise and start treating the surviving fish with Metro in their food and in the water and prophylactically treat the Koi tank the same way.
Based on the fact that you have been keeping fish, fresh and saltwater, for thirty years I am doubtful that this is a water quality issue, but it would be good for you to go ahead and provide the information that is requested in the
sticky at this link:
http://www.aquariacentral.com/forum...-Fish-Health-Diagnostics-(Read-before-posting.)
Photos would be helpful, if possible.
This is a bit of a "mystery" illness, it seems. You don't describe some of the signs and symptoms of other common bacterial illnesses that are more obvious, visibly, such as, Columnaris, aeromonas, strep or staph infections, nor do you describe any signs of external parasites, so this is a difficult case to diagnose.
Internal parasites are harder to diagnose, but usually you will see long stringy, thready, thin, white or clear poo, and often the belly may be swollen, or in the case of camallanus worms you may see them, intermittently, hanging down from the anus.
There are some internal protozoan infestations that might be a possiblity, but most of those aren't easily treatable, if at all, in some types.
If you go ahead and start treating for internal parasites with the Metro and don't see improvement, and if you see the Koi begin to get sick in spite of the prophylactic treatment, then I would get
UV sterilizers for the tanks. There are some relatively inexpensive ones on eBay that are
in- tank fully submersible units. The external
in-line ones are more expensive.
I'm very sorry for this distressing situation and so hope that things will improve. I also hope that the Metro will help and that this will prove to be a case of internal parasites.