The ornamental fish trade and aquarium hobby have grown exponentially, aided by the globalization of commerce and the ease of transport. However, the movement of ornamental fish also poses threats to ecosystems, animal health, and public health. Ornamental fishes may serve as carriers or vectors of potentially zoonotic organisms, including viral, bacterial, fungal and parasitic pathogens. Mycobacteriosis, caused by Mycobacterium spp. and exophiala infections are frequent among imported tropical freshwater fishes. Clinical signs vary from chronic wasting, skin lesions and hemorrhages to non-apparent infections, thus facilitating disease transmission to other fishes o r humans. Free-living pathogens are also dispersed to new habitats through aquarium release and contaminated water disposal. Protozoa like Cryptocaryon or Amyloodinium can produce disease both in marine fishes and humans, although unusual. Trematodes inhabiting freshwater and estuarine fishes utilize other animals as intermediate/paratenic hosts and are capable of infecting humans if infected fish are consumed raw or improperly cooked. However, the greatest public health risks from the ornamental fish trade likely come from exposing immunocompromised aquarists and fish-handlers to opportunistic bacterial, fungal, and mycobacterial infections. Thus, education regarding proper hygiene practices should accompany the promotion and sale of ornamental fishes. Additional research is needed to better characterize pathogens associated with the ornamental fish trade and implement biosecurity measures to prevent introduction of invasive organisms. This book chapter reviews the diversity of potential zoonotic organisms i dentified among imported ornamental fishes, pathological findings, transmission routes to humans, as well as diagnosis, treatment and preventive guidelines.