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Background  Lyme borreliosis in humans results in a range of clinical manifestations, thought to be partly due to differences in the pathogenicity of the infecting strain. This study compared European human clinical strains of  Borreliella afzelii  (previously named  Borrelia afzelii ) using multilocus sequence typing (MLST) to determine their spatial distribution across Europe and to establish whether there are associations between  B. afzelii  genotypes and specific clinical manifestations of Lyme borreliosis. For this purpose, typing was performed on 63 strains, and data on a further 245 strains were accessed from the literature.    Results  All 308 strains were categorized into 149 sequence types (STs), 27 of which are described here for the first time. Phylogenetic and goeBURST analyses showed short evolutionary distances between strains. Although the main STs differed among the countries with the largest number of strains of interest (Germany, the Netherlands, France and Slovenia), the  B. afzelii  clinical strains were less genetically structured than those previously observed in the European tick population. Two STs were found significantly more frequently in strains associated with clinical manifestations involving erythema migrans, whereas another ST was found significantly more frequently in strains associated with disseminated manifestations, especially neuroborreliosis.    Conclusions  The MLST profiles showed low genetic differentiation between  B. afzelii  strains isolated from patients with Lyme borreliosis in Europe. Also, clinical data analysis suggests the existence of lineages with differential dissemination properties in humans.    Electronic supplementary material  The online version of this article (10.1186/s13071-018-2938-x) contains supplementary material, which is available to authorized users.

Multilocus sequence typing of clinical Borreliella afzelii strains: population structure and differential ability to disseminate in humans