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.