Ulcerative lesions in estuarine finfish are associated with a variety of parasitic, bacterial, and fungal infectious agents as well as water quality and other abiotic stress factors. Atlantic menhaden Brevoortia tyrannus are a severely affected species typically exhibiting solitary, perianal, focal, deep, granulomatous lesions containing oomycete hyphae. Intense recent emphasis in the scientific literature and in the popular press has been placed on Pfiesteria-like dinoflagellates and their toxins as the causative agents for ulcerative finfish lesions in east coast estuaries of the United States. Dramatic descriptive terms for Pfiesteria, including "phantom," "ambush-predator" and "the cell from hell," capable of affecting humans, have appeared in scientific journals and the news media. However, there is no scientific evidence to date that supports a single, causal relationship between the presence of toxic Pfiesteria-like dinoflagellates and fish kills or the associated ulcerative lesions. This is due, at least in part, to the difficulty of maintaining toxic Pfiesteria-like dinoflagellates in clonal culture and, in part, to the presence of other microorganisms in laboratory culture systems. Further, there is at present no toxin-specific probe to identify Pfiesteria toxins in estuarine environments during fish kills, nor has Pfiesteria been isolated from fish lesions. Yet, based on the limited published scientific evidence and the popular press coverage, there have been river closures, notable economic losses, and public alarm due to Pfiesteria. Future research into agents infectious to menhaden, such as Aphanomyces (Oomycetes) and toxin-producing estuarine inhabitants like Pfiesteria, is needed. These organisms and the disease processes in which they are implicated may also serve as markers for overall estuarine condition. Control of microorganisms, including Pfiesteria, to improve finfish health in estuaries is unlikely. However, using the presence of these microorganisms and their Atlantic menhaden hosts as sentinels to help monitor water quality may be a viable approach to assist future estuarine management.