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Background   Anaplasma phagocytophilum  is a Gram-negative obligate intracellular bacterium that replicates in neutrophil granulocytes. It is transmitted by ticks of the  Ixodes ricinus  complex and causes febrile illness in humans and animals. The geographical distribution of  A. phagocytophilum  spans the Americas, Europe, Africa and Asia. However, human disease predominantly occurs in North America but is infrequently reported from Europe and Asia. In North American strains, the absence of the  drhm  gene has been proposed as marker for pathogenicity in humans whereas no information on the presence or absence of the  drhm  gene was available for  A. phagocytophilum  strains circulating in Europe. Therefore, we tested 511 European and 21 North American strains for the presence of  drhm  and compared the results to two other typing methods: multilocus sequence typing (MLST) and  ankA -based typing.    Results  Altogether, 99% (478/484) of the analyzable European and 19% (4/21) of the North American samples from different hosts were  drhm- positive. Regarding the strains from human granulocytic anaplasmosis cases, 100% (35/35) of European origin were  drhm- positive and 100% (14/14) of North American origin were  drhm- negative. Human strains from North America and Europe were both part of MLST cluster 1. North American strains from humans belonged to  ankA  gene clusters 11 and 12 whereas European strains from humans were found in  ankA  gene cluster 1. However, the North American  ankA  gene clusters 11 and 12 were highly identical at the nucleotide level to the European cluster 1 with 97.4% and 95.2% of identity, respectively.    Conclusions  The absence of the  drhm  gene in  A. phagocytophilum  does not seem to be associated with pathogenicity for humans  per se , because all 35 European strains of human origin were  drhm- positive. The epidemiological differences between North America and Europe concerning the incidence of human  A. phagocytophilum  infection are not explained by strain divergence based on MLST and  ankA  gene-based typing.

The absence of the drhm gene is not a marker for human-pathogenicity in European Anaplasma phagocytophilum strains