As stated repeatedly there is more than one cause so, yes, there are many cases where neither Hexamita spp. nor Spironucleus vortens are not present nor the cause in those cases. This does not disprove the cases where they are the cause, it just supports that there is more than one cause. Taking one or even many cases that support one cause and applying it to all cases is incorrect and unscientific.
If neither Hexamita spp. nor Spironucleus vortens are ever the cause then why are so many successfully treating for them and not changing anything else, yet the disease is cured and does not return? When my discus had HITH I treated with metronidazole and did NOT change anything else (diet, water quality, etc.). It quickly went away and has yet to return. What was the cause of their HITH that happened to go away exactly in conjunction with treatment of these parasites?
What species of fish were sick at that Vancouver aquarium? Different species are prone to different forms of HITH and HLLE (parasitic versus non-parasitic forms, different causes for HLLE, etc.).
What did they do to treat them?
Was it successful?
Marine HLLE is different than freshwater HLLE. It is well documented and demonstrated that marine HLLE is dietary. Saying they are the same is like saying that marine and freshwater ick are the same when we all know they are caused by two different parasites. So just because marine fish will not have either of these parasites does not mean that there are no cases of these parasites causing HITH in freshwater fish.
Please read the article in my blog on HITH and HLLE for more information about HITH and HLLE.
This is not a simple disease. It is not even a single disease. As demonstrated by the cases it is at least two different disease, one a disease caused by parasites (the usual form in angels and discus) which I refer to as HITH, and a non-parasitic that would be better classified as a symptom of many possible causes (like how dropsy has numerous causes that all result in the same symptom), which I refer to as HLLE. HLLE is more common in oscars, severums, managuenses, and even Synodontis spp.