I always QT, but it still doesn't get everything. About a year ago I bought some tiger barbs from one LFS in my area that is always recommended. I began QT and got white spots in the first week. I didn't really have a problems with this. My first instinct when buying fish is to expect white spots because it is so common(even though this was still the only time I have ever gotten them). Well I extended QT for another week and a half to make up for that time, put them in, and got internal parasites in my main tank from the new additions. My tigers(old and new) wasted away, stopped eating and out of 12(old and new), 4(2 new, 2 old) survived. I had my original 6 for a little over a year so I knew it was from the new fish. It took a month(after QT) for the parasite to spread throughout the main tank and kill my fish.
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