Closer attention to the distinct clinical features of the various spotted fever syndromes that exist in the United States and other countries of the Western hemisphere, coupled with more frequent use of specific confirmatory assays, may unveil several unique diseases that have been identified collectively as Rocky Mountain spotted fever during the past century. Accurate assessments of these distinct infections will ultimately provide a more valid description of the currently recognized distribution, incidence, and case-fatality rate of Rocky Mountain spotted fever.

Male ICR Swiss mice (2 to 3 months old) were fed Candida albicans in their drinking water for 3 days, followed by no treatment, antibiotics in their drinking water (daily), or immunosuppressants given by intraperitoneal injection (two to three times weekly) over a 3to 4-week period. The organs of animals were processed to determine the numbers of C. albicans and total aerobic bacteria per g of tissue. Untreated animals had mean Candida counts during the 1-month period of 102.3 CFU/g of cecum. Animals in six of eight antibiotic-treated groups had mean cecal Candida coun)ts higher than those of control animals (P < 0.05), with clindamycin-gentamicin producing the highest counts (104* CFU/g). Cyclophosphamide produced counts (104-3 CFU/g) which were higher (P < 0.05) than those resulting from methotrexate (103-°CFU/g) or steroid (102.7 CFU/g) treatment. Cyclophosphamide-clindamycin-gentamicin treatment was associated with the highest (P < 0.05) levels of Candida colonization (1065 CFU/g). Mice receiving immunosuppressants plus clindamycingentamicin were more likely to disseminate C. albicans than were mice receiving antibiotics alone (P < 0.001). Our findings suggest that colonization of the guts of mice by C. albicans can be facilitated by manipulating the aerobic, anaerobic, or both types of gut flora. The combiped effect of immunosuppressants on both Candida gut colonization and dissemination appears multifactorial and deserves further investigation.

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