Mycoplasma species in cats with lower airway disease: improved detection and species identification using a polymerase chain reaction assay

The respiratory microbiota and its impact on health and disease in dogs and cats: A One Health perspective

Healthy lungs were long thought of as sterile, with presence of bacteria identified by culture representing contamination. Recent advances in metagenomics have refuted this belief by detecting rich, diverse, and complex microbial communities in the healthy lower airways of many species, albeit at low concentrations. Although research has only begun to investigate causality and potential mechanisms, alterations in these microbial communities (known as dysbiosis) have been described in association with inflammatory, infectious, and neoplastic respiratory diseases in humans. Similar studies in dogs and cats are scarce. The microbial communities in the respiratory tract are linked to distant microbial communities such as in the gut (ie, the gut-lung axis), allowing interplay of microbes and microbial products in health and disease. This review summarizes considerations for studying local microbial communities, key features of the respiratory microbiota and its role in the gut-lung axis, current understanding of the healthy respiratory microbiota, and examples of dysbiosis in selected respiratory diseases of dogs and cats.

Outbreak management of multidrug-resistant Bordetella bronchiseptica in 16 shelter-housed cats

CASE SERIES SUMMARY

This case series describes an outbreak of multidrug-resistant (MDR) Bordetella bronchiseptica in 16 shelter-housed cats with infectious respiratory disease. Four cats presented with acute dyspnea on the same day, each with a history of previous upper respiratory disease that had resolved with treatment. Early diagnostic testing and culture and sensitivity allowed for targeted antimicrobial therapy and environmental interventions. A case definition based on exposure and clinical signs identified 12 additional presumptive cases, including the likely index case. Comprehensive outbreak management included diagnostic testing, risk assessment, vaccination, use of isolation and quarantine, increased surveillance and review of biosecurity practices. The outbreak resolved in 26 days.

RELEVANCE AND NOVEL INFORMATION

Management of an MDR B bronchiseptica outbreak in shelter-housed cats has not been previously described. Along with standard population and environmental measures, early and appropriate use of necropsy, PCR and bacterial culture allowed rapid and appropriate use of effective, second-line antibiotics. Shelters are resource-challenged population centers. Veterinarians working in animal shelters can play an important role in helping to develop cost-efficient and effective antimicrobial stewardship practices for companion animal settings. Outbreak management expertise and funding for diagnostic testing, as well as application of the principles of antimicrobial stewardship, are essential components of shelter medicine practice.

Respiratory dysbiosis in cats with spontaneous allergic asthma

Deviations from a core airway microbiota have been associated with the development and progression of asthma as well as disease severity. Pet cats represent a large animal model for allergic asthma, as they spontaneously develop a disease similar to atopic childhood asthma. This study aimed to describe the lower airway microbiota of asthmatic pet cats and compare it to healthy cats to document respiratory dysbiosis occurring with airway inflammation. We hypothesized that asthmatic cats would have lower airway dysbiosis characterized by a decrease in richness, diversity, and alterations in microbial community composition including identification of possible pathobionts. In the current study, a significant difference in airway microbiota composition was documented between spontaneously asthmatic pet cats and healthy research cats mirroring the finding of dysbiosis in asthmatic humans. Filobacterium and Acinetobacter spp. were identified as predominant taxa in asthmatic cats without documented infection based on standard culture and could represent pathobionts in the lower airways of cats. Mycoplasma felis, a known lower airway pathogen of cats, was identified in 35% of asthmatic but not healthy cats. This article has been published alongside "Temporal changes of the respiratory microbiota as cats transition from health to experimental acute and chronic allergic asthma" (1).

A retrospective study on the presence of selected infectious agents in lung samples of cats with pneumonia

The causative role of some infectious agents found in cases of feline pneumonia is under debate, because they are also part of the physiological microbiota of the respiratory tract of healthy animals. In this retrospective study, archived formalin-fixed and paraffin-wax-embedded lung samples of 69 severe and lethal cases of pneumonia in cats were examined by immunohistochemistry (IHC) for the detection of nine selected infectious agents: Pasteurella multocida, Bordetella bronchiseptica, Mycoplasma felis, M. gateae, Chlamydia felis, feline herpesvirus type 1, feline coronavirus, canine distemper virus, and Toxoplasma gondii. The intention was to elucidate their immediate involvement in pneumonia formation. Due to the cross-reactivity of the applied antibodies, a species-specific polymerase chain reaction (PCR) for both targeted Mycoplasma species was applied additionally. In the 42 cases (60.9%) positive for at least one pathogen, several agents were present in a high proportion of the samples (P. multocida - 34.8%, B. bronchiseptica - 29.0%), while others were present in a moderate (feline herpesvirus type 1 - 18.8%, M. gateae - 13.0%, M. felis - 10.1%) or low percentage (T. gondii - 1.4%). All samples were negative for C. felis, feline coronavirus and canine distemper virus. Mixed infections of up to four pathogens were more frequent than single infections. Mycoplasma preferably colonised lung tissue damaged by other pathogens because they never occurred as single infections. Pasteurella multocida, B. bronchiseptica, M. felis, feline herpesvirus type 1 and T. gondii showed abundant replication within lung lesions, thus suggesting a prominent role in pneumonia formation.

A systematic review and meta-analyses of the association between 4 mycoplasma species and lower respiratory tract disease in dogs

Background

The pathogenic role of mycoplasmas in the lower respiratory tract (LRT) of dogs is debated, because mycoplasmas can be isolated from both healthy and sick dogs.

Objectives

To critically assess available data from controlled observational studies on the role of 4 mycoplasma species in LRT disease of dogs.

Design

Systematic review and meta‐analyses.

Methods

Seven electronic databases were searched for relevant publications. Risk of bias was assessed by the Newcastle‐Ottawa Scale. Meta‐analyses, stratified by mycoplasmal species, were performed using a random effects Bayesian model with noninformative priors to estimate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the association between Mycoplasma cynos, Mycoplasma canis, Mycoplasma spumans, and Mycoplasma edwardii and LRT disease in dogs.

Results

Five studies were included from 1201 references identified. All studies dealt with M. cynos, whereas 3 dealt with the other mycoplasma species. A significant association was found between M. cynos and LRT disease (Bayesian OR, 3.60; CI, 1.31‐10.29). Conversely, M. canis, M. spumans, and M. edwardii were not significantly associated with LRT signs (Bayesian OR, 1.06; CI, 0.10‐14.63; Bayesian OR, 3.40; CI, 0.16‐54.27; and Bayesian OR, 1.04; CI, 0.05‐23.54, respectively).

Conclusions and Clinical Importance

Results support a pathogenic role of M. cynos and a commensal role of M. canis and M. edwardii in LRT in dogs. Although the association was not significant based on the CI, the point estimate of the Bayesian OR was relatively high for M. spumans, making its role less clear. Mycoplasma cynos‐specific polymerase chain reaction should be considered on samples from dogs with LRT.

A systematic review and meta-analysis of the association between Mycoplasma spp and upper and lower respiratory tract disease in cats

OBJECTIVE To critically assess available data from controlled observational studies on the pathogenic role of Mycoplasma spp in the upper respiratory tract (URT) and lower respiratory tract (LRT) of cats. DESIGN Systematic review and meta-analysis. SAMPLE 12 studies. PROCEDURES Seven electronic databases were searched for relevant publications. Risk of bias was assessed via the Newcastle-Ottawa Scale. Meta-analyses, stratified by URT versus LRT disease, were performed to estimate pooled ORs and 95% confidence intervals (CIs) for the association between Mycoplasma isolation and URT or LRT disease. Subanalyses by diagnostic method, sampling site, and environment (shelter vs nonshelter) were planned for studies on URT disease. RESULTS A significant association was found between isolation of mycoplasmal organisms and URT disease (pooled OR, 1.65; 95% CI, 1.14 to 2.40) but not LRT disease (pooled OR, 1.56; 95% CI, 0.51 to 4.76). The association with URT disease was only significant when conjunctival or pharyngeal samples from nonshelter cats were analyzed with a Mycoplasma felis-specific PCR assay. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that M felis may be a primary pathogen in cats with URT disease, warranting treatment in infected cats. The environment was important to consider when interpreting a mycoplasma-positive sample because of aclinical carriage, especially in shelter cats. Further investigations are needed to determine the role, if any, of mycoplasmal organisms in LRT disease of cats.

Detection of feline Mycoplasma species in cats with feline asthma and chronic bronchitis

Little is known about the aetiology of inflammatory lower airway disease in cats. The aim of this study was to investigate the role of Mycoplasma species in cats with feline asthma (FA) and chronic bronchitis (CB). The study population consisted of 17 cats with FA/CB, and 14 sick cats without clinical and historical signs of respiratory disease, which were euthanased for various other reasons. Nasal swabs, nasal lavage and bronchoalveolar lavage fluid (BALF) samples were taken from patients from both groups. Mycoplasma species culture with modified Hayflick agar and Mycoplasma polymerase chain reaction (PCR) were performed on all samples followed by sequencing of all Mycoplasma species-positive samples for differentiation of subspecies. PCR testing detected significantly more Mycoplasma species-positive BALF samples than Mycoplasma culture (P = 0.021). When cats with oropharyngeal contamination were excluded from comparison, the numbers of Mycoplasma species-positive BALF samples in the group with FA/CB (6/17) and the control group (4/9) were not significantly different (P = 0.6924). While all nasal samples of the cats with FA/CB were negative for Mycoplasma organisms, five samples in the control group (P = 0.041) were positive on PCR. Sequencing revealed Mycoplasma felis in all PCR-positive samples. Mycoplasma species can be detected in the lower airways of cats with FA/CB, as well as in the BALF of sick cats without respiratory signs. Further studies are warranted to investigate the possibility that Mycoplasma species represent commensals of the lower respiratory tract of cats.

Feline respiratory disease: what is the role of Mycoplasma species?

PRACTICAL RELEVANCE

Non-hemotropic Mycoplasma species are frequently implicated in cases of respiratory disease, and also conjunctivitis, in cats.

CLINICAL CHALLENGES

Mycoplasma species are considered commensal bacteria of the conjunctiva and the upper respiratory tract of cats, and hence their role as a primary pathogen is difficult to determine. These organisms certainly appear to play a significant role as a secondary pathogen in the upper airways, and there is increasing evidence that in some animals they may represent a primary infection. However, mycoplasmas have not been found in the lower airways of clinically healthy cats - suggesting that, when present, they likely represent a pathologic process. Diagnostic challenges exist as well; Mycoplasma species are not typically identified via cytology due to their small size, and culture of these organisms requires special media and handling. Although PCR has improved identification and allowed for speciation, conflicting culture and PCR results can create a dilemma regarding the clinical relevance of infection.

EVIDENCE BASE

This article draws on original research and case reports to provide information about the role of Mycoplasma species in the feline upper and lower respiratory tract, diagnostic methods and associated challenges, and treatment options.

AUDIENCE

The goal is to provide small animal practitioners with a current and organized review of the often-conflicting literature regarding the role of Mycoplasma species in feline respiratory infections.