It looks to me like it has ich and many times columnaris presents itself as a secondary infection. It's quite advanced and I would suggest using a medicine like Clout since most other conventional meds would probably not do much good at this point. You need to raise the temp to around 82-85F to speed up the ich life cycle and increase surface aeration since the medication and temp will decrease oxygenation of the water. Make sure that you continue to treat even after symptoms are gone for a two week term using Clout. If it doesn't respond to treatment then euthanasia is an alternative. Clove oil or lidocaine can be used quite effectively for that purpose.
