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The acute disease antigen A ( adaA ) gene is believed to be associated with  Coxiella burnetii  strains causing acute Q fever. The detailed analysis of the  adaA  genomic region of 23 human- and 86 animal-derived  C. burnetii  isolates presented in this study reveals a much more polymorphic appearance and distribution of the  adaA  gene, resulting in a classification of  C. burnetii  strains of better differentiation than previously anticipated. Three different genomic variants of the  adaA  gene were identified which could be detected in isolates from acute and chronic patients, rendering the association of  adaA  positive strains with acute Q fever disease disputable. In addition, all  adaA  positive strains in humans and animals showed the occurrence of the QpH1 plasmid. All  adaA  positive isolates of acute human patients except one showed a distinct SNP variation at position 431, also predominant in sheep strains, which correlates well with the observation that sheep are a major source of human infection. Furthermore, the phylogenetic analysis of the  adaA  gene revealed three deletion events and supported the hypothesis that strain Dugway 5J108-111 might be the ancestor of all known  C. burnetii  strains. Based on our findings, we could confirm the QpDV group and we were able to define a new genotypic cluster. The  adaA  gene polymorphisms shown here improve molecular typing of Q fever, and give new insights into microevolutionary adaption processes in  C. burnetii .

Microevolution of the Chromosomal Region of Acute Disease Antigen A (adaA) in the Query (Q) Fever Agent Coxiella burnetii