There is a bewildering array of fish parasites and probably all fish species harbour one or more species. Under normal conditions hosts often show little or no signs of infection, either clinically or at the organ and tissue level. All tissues can be infected, including the blood. Coelozoic species generally do not elicit significant host responses. Any developmental stages, however, where these migrate through the host tissues may produce a cellular response if resident for sufficient time. Histozoic parasites are generally more likely to evoke a pathological response since they are invariably in more intimate contact with immunocompetent host cells such as lymphocytes and phagocytes. In some cases, particularly with protistan infections, host response can be dramatic and cause significant disease due to organ dysfunction, with subsequent mortalities. Infections of the external epithelia caused by a variety of parasites including Monogenea and Copepoda are also significant, especially when large numbers are present. Resulting tissue necrosis compromises osmoregulation and facilitates entry of prokaryote infections. Parasites have numerous strategies to evade detection within the host, but even ‘protected’ intracellular forms, e.g. microsporeans and muscle‐invading myxozoans are recognized when they outgrow their accommodation or large cysts rupture, presenting parasite antigens to the host. In most instances, an evolutionary balance has been achieved between the host and the parasite and even when histopathology is evident, this is frequently localized and does not unduly impair performance of the affected organ. Examples include chronic inflammation, granuloma formation and focal fibrosis. This paper outlines the principle histopathological responses to a variety of parasite groups and provides a more detailed treatment of selected parasitic infections in marine and freshwater fish species to illustrate the relative importance of acute and chronic parasitic infections for host survival.