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Anaplasma

Anaplasma is a genus of Gram-negative, obligate intracellular bacteria in the family Anaplasmataceae, order Rickettsiales, class Alphaproteobacteria, and phylum Pseudomonadota.^[1] These small, pleomorphic, non-motile cocci, measuring 0.3–0.4 µm, are aerobic and form characteristic morulae within the vacuoles of host cells such as erythrocytes and granulocytes; they cannot be cultured on cell-free media.^[1] Primarily transmitted by ticks, Anaplasma species infect a wide range of vertebrate hosts, including ruminants, dogs, horses, rodents, and humans, causing zoonotic and veterinary diseases known as anaplasmoses.^[2] The genus comprises eight recognized species: A. marginale (the type species), A. centrale, A. ovis, A. bovis, A. phagocytophilum, A. platys, A. capra, and A. odocoilei.^[3] Key species include A. marginale, which causes bovine anaplasmosis—a severe hemolytic disease in cattle transmitted by ticks such as Dermacentor and Rhipicephalus species—and A. phagocytophilum, responsible for human granulocytic anaplasmosis (HGA) and equine granulocytic anaplasmosis, primarily vectored by Ixodes ticks.^[4] Other species like A. platys infect canine platelets, leading to cyclic thrombocytopenia, while A. capra has been associated with human infections in regions like China.^[5] Anaplasma bacteria exhibit complex interactions with their arthropod vectors and vertebrate hosts, colonizing tick midgut and salivary gland cells to facilitate transmission.^[2] Infections often present with fever, lethargy, and anemia in animals, and flu-like symptoms in humans, with potential complications such as thrombocytopenia and leukopenia; early antibiotic treatment with tetracyclines is effective.^[4] Due to their global distribution and emerging zoonotic potential, Anaplasma species pose significant public health and economic concerns, particularly in livestock industries, with ongoing research focusing on vector competence and vaccine development.^[2]

Taxonomy

Classification

The genus Anaplasma is classified within the family Anaplasmataceae, order Rickettsiales, class Alphaproteobacteria, and phylum Pseudomonadota (formerly known as Proteobacteria).^[1] This taxonomic placement reflects its position among obligate intracellular bacteria in the Alphaproteobacteria class.^[6] Phylogenetically, Anaplasma species are closely related to Ehrlichia and other members of the Anaplasmataceae family, as evidenced by molecular analyses of 16S rRNA and groESL genes, which demonstrate shared evolutionary ancestry and genetic similarities within the order Rickettsiales.^[7] These analyses highlight the genus's position as part of a monophyletic group of tick-borne pathogens.^[8] The genus Anaplasma is delineated by key characteristics, including being Gram-negative, obligate intracellular bacteria that replicate within membrane-bound vacuoles in host blood cells, and are primarily transmitted by arthropod vectors such as ticks.^[9] At the family level, Anaplasmataceae encompasses the genera Anaplasma, Ehrlichia, Neorickettsia, and Wolbachia, with Anaplasma distinguished by its specific tropism for erythrocytes or granulocytes in vertebrate hosts.^[10] For instance, species like A. marginale and A. phagocytophilum exemplify this genus-level tropism.^[11]

History

The genus Anaplasma traces its origins to the early 20th century, when Sir Arnold Theiler identified A. marginale as a novel pathogen during research conducted in South Africa from 1908 to 1909. Theiler described it in 1910 as intraerythrocytic bodies in cattle blood, distinguishing them from previously known parasites and naming the organism Anaplasma marginale for its marginal position within red blood cells; this marked the first recognition of a rickettsial pathogen in veterinary medicine.^[12]^[13] Early observations in the 1910s and 1920s established A. marginale as the causative agent of bovine anaplasmosis, a tick-transmitted disease leading to fever, anemia, and high mortality in cattle, though it was initially confused with babesiosis due to the shared intraerythrocytic location of the pathogens.^[14] In 1932, a similar tick-borne fever was reported in sheep in Scotland, later attributed to what is now known as A. phagocytophilum, though the etiological agent remained unnamed at the time and was not formally linked to the genus until decades later.^[15]^[16] The 1990s brought significant milestones with the identification of human granulocytic ehrlichiosis (HGE), first recognized in 1994 as a emerging tick-borne illness affecting neutrophils, initially classified under Ehrlichia.^[17] A pivotal reclassification occurred in 2001, when molecular phylogenetic analyses, including 16S rRNA gene sequencing, redefined the genus Anaplasma within the family Anaplasmataceae, incorporating species previously under Ehrlichia such as the HGE agent, formally named A. phagocytophilum, and expanding the genus to include A. bovis and A. platys.^[18]^[19] This restructuring renamed HGE as human granulocytic anaplasmosis, reflecting the pathogen's true taxonomic position.^[17]

Biology

Morphology

Anaplasma species are Gram-negative, obligate intracellular bacteria characterized as small, pleomorphic cocci or coccobacilli, typically measuring 0.2–1.0 μm in diameter, though sizes can range up to 2 μm in some forms.^[20] They are non-motile and lack flagella, adapting to an intracellular lifestyle without the need for motility.^[21] These bacteria exhibit two distinct morphotypes observed under electron microscopy: reticulate cells, which are larger and contain loosely arranged nucleoids and ribosomes, and dense-core cells, which are smaller with compact nucleoids, representing developmental stages within host cells.^[20] The ultrastructure of Anaplasma reveals a double-membrane envelope typical of Gram-negative bacteria, but uniquely lacking a peptidoglycan layer in the periplasmic space, which is often irregular due to a ruffled outer membrane.^[20] The cytoplasm is ribosome-rich, supporting active protein synthesis, and fine DNA strands are visible, with no lipopolysaccharide in the outer membrane.^[20] Within host cells, Anaplasma bacteria replicate in membrane-bound vacuoles, forming characteristic morulae—mulberry-like clusters of 10–40 organisms that can reach 1.5–6 μm in diameter.^[20] In stained preparations, Anaplasma are not readily visible with standard Gram staining due to the absence of peptidoglycan but appear as basophilic inclusions in Giemsa- or Wright-stained blood smears, often purple or dark blue against the host cell background.^[20] Electron microscopy further highlights the ribosome-dense cytoplasm and lack of a cell wall, confirming their rickettsial nature.^[20] Species-specific variations in morphology include the positioning of inclusions: A. marginale forms round to oval inclusions typically located at the margin of bovine erythrocytes, appearing as peripheral basophilic bodies 0.3–1.0 μm in size on Giemsa-stained smears.^[14] In contrast, A. phagocytophilum inclusions occupy cytoplasmic vacuoles in neutrophils, often aligning with or resembling altered neutrophil granules, visible as intracytoplasmic clusters in stained leukocyte preparations.^[20]

Life Cycle

Anaplasma species are obligate intracellular bacteria that replicate exclusively within membrane-bound vacuoles in host cells, undergoing a developmental cycle without sporulation or cyst formation.^[22] The infectious dense-cored cells, also known as elementary bodies, enter host cells through endocytosis and differentiate into larger reticulate bodies, which multiply by binary fission to form intracellular clusters called morulae.^[20] These reticulate bodies subsequently undergo asymmetric, sacrificial division to form new dense-cored cells resembling sporulation, which are released to initiate subsequent infections in neighboring cells.^[22]^[23] Host cell tropism varies by species, determining the site of replication within the vertebrate host. For instance, A. marginale primarily infects bovine erythrocytes, where reticulate forms divide by binary fission within vacuoles, leading to hemolytic anemia in cattle.^[24] In contrast, A. phagocytophilum targets granulocytes such as neutrophils in mammals, including humans and animals, replicating inside specialized vacuoles that avoid lysosomal fusion. Recent studies (as of 2025) have shown that in A. phagocytophilum, reticulate cell replication occurs synchronously from 4–18 hours post-infection, followed by asynchronous conversion to dense-cored cells via asymmetric division involving the MreB protein, advancing understanding of infection dynamics and transmission.^[20]^[23] A. platys, specific to canines, infects platelets, resulting in a cyclic infection pattern with morula formation every 1–2 weeks, corresponding to waves of thrombocytopenia.^[25] In the arthropod vector phase, Anaplasma undergoes transstadial transmission in ticks, persisting through larval, nymphal, and adult stages without transovarial passage to eggs.^[20] Bacteria multiply by binary fission in tick midgut epithelial cells and salivary glands, similar to the host cycle but without pronounced morphological distinctions between forms; for A. phagocytophilum, this occurs in Ixodes species, while A. marginale replicates in Rhipicephalus ticks such as R. microplus.^[22] Morulae, visible as basophilic inclusions in Giemsa-stained host cells, represent the replicative stage and are a diagnostic hallmark across species.^[20]

Genomics

Genome Structure

The genomes of Anaplasma species consist of a single circular chromosome with sizes ranging from 1.05 to 1.5 million base pairs (Mbp). For example, the genome of A. marginale strain St. Maries measures 1,197,687 bp, while that of A. phagocytophilum strain HZ is 1,471,282 bp.^[26]^[27] The GC content varies between 37% and 50% across species, with A. marginale exhibiting approximately 49.8% and A. phagocytophilum around 41.6%.^[26]^[28] This compact architecture reflects the obligate intracellular lifestyle of these bacteria, featuring high coding densities typically exceeding 80%.^[26] Gene content in Anaplasma genomes includes approximately 900 to 1,300 protein-coding genes, with a substantial fraction—often 40-50%—comprising hypothetical proteins of unknown function.^[29]^[30] For instance, the A. marginale St. Maries genome encodes 949 coding sequences, of which a significant portion are annotated as hypothetical.^[26] Similarly, A. phagocytophilum HZ has 1,327 predicted protein-coding genes, with over half classified as hypothetical or conserved hypothetical proteins.^[27] Metabolic capabilities are limited, supporting essential pathways such as glycolysis but lacking genes for de novo biosynthesis of most amino acids, necessitating reliance on host-derived nutrients.^[30] In contrast, pathways for nucleotide biosynthesis, including complete purine and pyrimidine routes, are present in species like A. marginale.^[26] Prominent gene families include those encoding major surface proteins (MSPs), which facilitate antigenic variation. The MSP1 and MSP2 superfamilies are expanded in Anaplasma genomes; for example, A. marginale contains 9 MSP1 family members and 56 MSP2 superfamily members (including pseudogenes), while A. phagocytophilum features over 100 p44/MSP2 paralogs.^[26]^[31] Genes for the type IV secretion system (T4SS), essential for host cell entry, are conserved and organized in operons, with A. marginale encoding VirB and VirD4 components across two loci.^[26] Plasmids are uncommon in Anaplasma and, when present, are small and non-essential. Some A. marginale strains harbor plasmids of 5-10 kb, such as the 4.9 kb pAM36 in the Florida strain, which may carry conjugation-related genes but are not universally required for viability.^[32] No plasmids have been identified in A. phagocytophilum genomes.^[33]

Sequencing and Comparative Analysis

The first complete genome of an Anaplasma species was that of A. marginale strain St. Maries, sequenced in 2005, revealing a 1.2 Mbp circular chromosome dominated by outer membrane protein (OMP) genes that contribute to antigenic variation and immune evasion.^[26] This milestone highlighted the bacterium's compact genome adapted to intracellular parasitism, with over 1,000 genes, including those encoding major surface proteins like MSP1 and MSP2.^[26] Subsequent sequencing efforts expanded to other species, including the complete genome of A. phagocytophilum strain HZ in 2006, approximately 1.4 Mbp in size, which provided insights into its broader host range and virulence factors. In the 2010s, draft assemblies were generated for A. ovis and A. bovis, facilitating initial comparative studies, while more recent projects in the 2020s include whole-genome sequences of Mexican A. marginale strains and a Chinese A. bovis isolate representing the smallest known Anaplasma genome at 1.05 Mbp.^[34]^[35]^[36] Draft genomes of A. capra strains, each approximately 1.07 Mbp in size, were published in 2023, revealing its compact structure with 862 protein-coding genes and limited metabolic pathways similar to other species.^[37] Comparative genomic analyses across Anaplasma species underscore genome reduction as a hallmark of their obligate intracellular lifestyle, with sizes ranging from 1.05 to 1.5 Mbp and reduced metabolic capabilities compared to free-living relatives.^[38] Shared features include the type IV secretion system (T4SS) essential for host cell invasion and ankyrin repeat-containing genes involved in protein-protein interactions, conserved across species to support pathogenesis.^[39] Notably, A. phagocytophilum genomes exhibit a higher proportion of pseudogenes than A. marginale, reflecting greater evolutionary flux and potential for host adaptation.^[31] Genomic diversity within Anaplasma is driven by mechanisms such as recombination in the msp2/p44 gene families, enabling rapid antigenic variation to evade host immunity, as observed in multiple strains.^[40] Strain typing commonly relies on sequencing the 16S rRNA gene and groESL operon, which reveal intraspecies polymorphisms useful for epidemiological tracking.^[41] While genomes are available for most major Anaplasma species, complete sequences remain absent for A. odocoilei, and A. capra has only recently seen draft assemblies from emerging isolates.^[38]^[37]

Species

Major Species

Anaplasma marginale is the primary pathogen within the genus affecting cattle, where it resides obligately within erythrocytes, leading to severe hemolytic anemia in infected hosts. This species is distributed worldwide, particularly in tropical and subtropical regions, with high prevalence in cattle populations across Latin America, Africa, and parts of North America. Key distinguishing traits include its small genome of approximately 1.2 million base pairs and the expression of major surface proteins (MSPs) such as MSP1a and MSP2, which facilitate adhesion to host cells and antigenic variation for immune evasion. Transmission occurs primarily via ticks like Dermacentor and Rhipicephalus species, as well as mechanical vectors such as biting flies.^[14] Anaplasma phagocytophilum targets granulocytes, including neutrophils, in a broad range of hosts such as humans, ruminants, horses, dogs, and wildlife like rodents and deer. It is the causative agent of human granulocytic anaplasmosis and tick-borne fever in animals, with infections often presenting as subclinical or mild febrile illnesses. This species exhibits a global distribution, with notable endemicity in the northeastern and upper midwestern United States, northern Europe, and parts of Asia, primarily transmitted by Ixodes ticks. Distinguishing features include its ability to inhibit neutrophil antimicrobial functions and replicate within membrane-bound vacuoles, supported by a genome encoding type IV secretion systems for host cell manipulation.^[42]^[43] Anaplasma ovis primarily infects erythrocytes of small ruminants, including sheep and goats, resulting in a milder form of anaplasmosis compared to bovine counterparts. It is endemic in tropical and subtropical areas, with significant prevalence in the Mediterranean basin, Middle East, Africa, and parts of Asia. Transmission is tick-borne, mainly by Rhipicephalus species, and the bacterium shows genetic diversity in genes like msp4, allowing for strain variation across regions. Unlike more virulent relatives, A. ovis often causes subclinical infections with low parasitemia levels.^[44]^[43] Anaplasma centrale, a less virulent species closely related to A. marginale, infects cattle erythrocytes but induces a less severe disease, making it valuable as an attenuated live vaccine to mitigate acute bovine anaplasmosis. It is utilized in vaccination programs in regions like Africa, Australia, and parts of South America, where it provides cross-protection against A. marginale without fully preventing infection. Key traits include reduced transmissibility by ticks—requiring high tick densities for spread—and shared immunodominant antigens with A. marginale, such as certain MSPs, which contribute to its vaccine efficacy. Distribution is tied to endemic cattle areas, though regulatory restrictions limit its use in places like the United States and European Union due to potential risks.^[14]^[45] Anaplasma platys specifically targets platelets in dogs, forming intracytoplasmic morulae and causing infectious cyclic thrombocytopenia characterized by periodic platelet count fluctuations. First described in 1978, it has a cosmopolitan distribution, with higher incidence in tropical and subtropical zones, transmitted predominantly by the brown dog tick Rhipicephalus sanguineus. Distinguishing morphological features include basophilic inclusions within platelets, and molecularly, it possesses genes for platelet adhesion. Infections are often mild and self-limiting in healthy dogs.^[46]^[43] Anaplasma bovis resides in monocytes and macrophages of ruminants, particularly cattle and wild species like buffalo, and is considered an emerging pathogen with generally low pathogenicity leading to subclinical infections. It is prevalent in Asia, Africa, and parts of Europe and South America, with recent detections extending to North America. Transmission involves ticks such as Haemaphysalis and Rhipicephalus genera, and genomic analyses reveal a compact genome similar to other Anaplasma species, encoding effectors for intracellular survival. Compared to erythrocyte-infecting relatives, A. bovis is less studied, with ongoing research into its zoonotic potential.^[43]^[47] Anaplasma caudatum infects granulocytes in cervids such as reindeer, causing mild or subclinical infections. It is primarily found in northern Europe and Asia, transmitted by ticks like Ixodes persulcatus, and is distinguished by its host specificity and limited geographic range compared to other species.^[48]

Emerging and Candidatus Species

Emerging and Candidatus species of Anaplasma represent provisional taxa identified through molecular methods but not yet formally classified due to challenges in isolation and cultivation. These entities highlight the expanding diversity within the genus, often detected in novel hosts or vectors via PCR amplification of genes like 16S rRNA. Their provisional status underscores the limitations of current taxonomic criteria for obligate intracellular bacteria, which require viable cultures for official naming.^[49] One prominent example is Candidatus Anaplasma odocoilei, first detected in white-tailed deer (Odocoileus virginianus) in the United States during the 2000s using 16S rRNA gene sequencing. This granulocyte-tropic agent was identified in neutrophils of experimentally infected deer, eliciting antibody responses detectable by indirect fluorescent antibody testing, and phylogenetic analysis placed it within the Anaplasma genus, closely related to A. phagocytophilum. Proposed as a novel species, A. odocoilei, in 2013, its status reflects reliance on molecular detection without in vitro propagation.^[50] Similarly, Candidatus Anaplasma capra was proposed in 2015 following its detection in goats (Capra hircus) in China, where it causes febrile illness in infected animals and has zoonotic potential in humans. Identification relied on sequencing of the groEL and 16S rRNA genes from blood samples, revealing intraerythrocytic morulae and phylogenetic clustering distinct from established species. This tick-borne pathogen, primarily associated with Haemaphysalis ticks, was initially found in 31% of asymptomatic goats in northern China via 16S rRNA PCR.^[51] Other provisional candidates include novel Anaplasma strains detected in African wildlife, such as those in impala, buffalo, and other ungulates, provisionally termed variants like "Ca. A. africanum" based on 16S rRNA and multi-locus sequencing from blood and tick samples. In South America, Candidatus Anaplasma amazonensis has been identified in ticks and hosts like cats via PCR targeting 16S rRNA, marking its first molecular detection in the Amazon region and suggesting broader ecological roles in neotropical vectors. These detections often occur through PCR screening of vectors and reservoirs, revealing genetic diversity without cultured isolates.^[52]^[53] Key challenges in characterizing these Candidatus species stem from the inability to culture Anaplasma in vitro, necessitating dependence on molecular tools like 16S rRNA PCR, which has limitations in species-level resolution due to sequence similarities. This reliance hinders fulfillment of taxonomic requirements, such as depositing type strains, and raises concerns about potential undescribed species in global rodent and tick populations. Recent research from 2017 to 2022 has increasingly documented co-infections of multiple Anaplasma variants in ticks like Haemaphysalis longicornis and H. flava, suggesting ecological interactions that may drive emergence and complicate detection.^[54]^[55]

Pathogenesis

Infection Mechanisms

Anaplasma species, as obligate intracellular bacteria, initiate infection by entering host cells primarily through attachment mediated by surface adhesins, followed by internalization via a type IV secretion system (T4SS) that injects effector proteins to manipulate host processes.^[20] In A. phagocytophilum, the T4SS, encoded by the virB operon, secretes effectors such as AnkA, an ankyrin repeat protein translocated into the host cytoplasm within minutes of bacterial contact.^[56] AnkA undergoes tyrosine phosphorylation by the host kinase Abl-1, which activates signaling pathways that facilitate bacterial uptake while inhibiting phagolysosome fusion, thereby preventing degradation in acidified compartments.^[56] This entry mechanism ensures the bacteria reside in a modified vacuole conducive to replication without immediate lysosomal targeting.^[20] Once internalized, Anaplasma modifies its pathogen-occupied vacuole (POV) to promote survival by excluding lysosomal markers such as LAMP-1 and V-type H⁺-ATPase, recruiting components from recycling endosomes and early endosomes instead.^[20] The POV interacts with the host endoplasmic reticulum and avoids fusion with autophagosomes or NADPH oxidase-containing vesicles, reducing reactive oxygen species production that could harm the bacteria.^[57] For nutrient acquisition, Anaplasma lacks genes for de novo synthesis of essential lipids and instead scavenges host cholesterol by upregulating low-density lipoprotein (LDL) receptors via T4SS effectors, enabling membrane biogenesis for bacterial division within the expanding POV.^[20] Surface proteins like major surface protein 2 (MSP2), encoded in the bacterial genome, further aid in anchoring the POV to host membranes for nutrient transport.^[20] Immune evasion is achieved through antigenic variation and suppression of host responses, allowing persistent replication. In A. phagocytophilum, the bacterium employs over 100 MSP2/p44 pseudogene cassettes that undergo recombination to generate variant surface proteins, altering epitopes to escape antibody recognition during chronic infection.^[20] Replication culminates in bacterial release via host cell lysis, where densely packed morulae burst the POV and cell membrane, or potentially through direct cell-to-cell transfer to adjacent host cells.^[20] Released bacteria disseminate via the bloodstream to infect new cells, perpetuating the cycle without extracellular persistence.^[20]

Host Interactions

Anaplasma species interact with their hosts by modulating immune responses and inducing specific pathological changes, primarily through intracellular replication that damages host cells. This replication within host cells leads to direct cytotoxicity and triggers immune-mediated clearance, contributing to tissue pathology across various species.^[58] In A. phagocytophilum, a key immune modulation strategy involves the inhibition of reactive oxygen species (ROS) production in neutrophils, despite stimulating NADPH oxidase assembly. The bacterium scavenges extracellular superoxide in a dose-dependent manner and resides in a vacuole that excludes essential oxidase components like gp91phox and p22phox, thereby evading oxidative killing.^[59] Additionally, A. phagocytophilum upregulates the NF-κB pathway in infected neutrophils to promote anti-apoptotic gene expression, such as BCL2A1 and GADD45B, prolonging host cell survival and facilitating bacterial propagation. It induces production of chemokines such as IL-8, which promotes recruitment of additional neutrophils.^[60]^[20] Pathological effects vary by species tropism. In erythrocytic A. marginale, infection causes hemolytic anemia through extravascular destruction of both infected and uninfected erythrocytes by macrophages in the spleen, liver, and bone marrow, with peak parasitization reaching 10–65% of red blood cells during acute phases.^[58] For A. platys, which targets platelets in dogs, thrombocytopenia arises initially from direct replication-induced injury to platelets forming morulae inclusions, followed by immune-mediated destruction of infected cells, resulting in cyclic platelet declines.^[61] Co-infections with Anaplasma species and other tick-borne pathogens such as Borrelia burgdorferi or Babesia microti are common in tick vectors and can occur in humans, with some animal studies suggesting potential for increased severity, though evidence in humans remains inconclusive.^[62]^[63] The host range of Anaplasma primarily encompasses ruminants, with domestic species like cattle, sheep, and goats serving as key reservoirs for A. marginale and A. phagocytophilum, while wildlife such as roe deer (up to 98.9% prevalence) and white-tailed deer act as maintenance hosts.^[64] Humans function as accidental dead-end hosts for A. phagocytophilum, experiencing granulocytic anaplasmosis without sustaining transmission cycles.^[64]

Transmission and Epidemiology

Vectors and Transmission

Anaplasma species are primarily transmitted by hard-bodied ticks of the family Ixodidae, which serve as biological vectors through a process involving bacterial replication within the tick.^[65] These ticks acquire the bacteria during blood meals on infected hosts and subsequently transmit them to new hosts via injection of infected saliva during feeding.^[66] The transmission is transstadial, meaning the pathogen passes from one life stage of the tick to the next (larva to nymph to adult), but it is non-transovarial, with no passage from female ticks to their eggs.^[67] Specific tick vectors are associated with different Anaplasma species. For Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis, the primary vectors in North America are Ixodes scapularis (blacklegged tick) and Ixodes pacificus (western blacklegged tick), where nymphs and adult females are the main transmitting stages after acquiring infection as larvae.^[11] Anaplasma marginale, responsible for bovine anaplasmosis, is vectored mainly by Dermacentor species such as Dermacentor andersoni (Rocky Mountain wood tick) and Dermacentor variabilis (American dog tick) in the United States.^[68] For bovine pathogens including A. marginale, Rhipicephalus microplus (Asian blue tick) acts as a key vector in tropical regions like Australia and Africa.^[58] Anaplasma ovis, which infects sheep and goats, is transmitted by ticks of the genus Amblyomma, along with species from Ixodes, Dermacentor, and Rhipicephalus genera.^[69] Anaplasma platys, causing cyclic thrombocytopenia in dogs, is primarily vectored by Rhipicephalus sanguineus (brown dog tick).^[70] Anaplasma capra, an emerging zoonotic species, is transmitted by ticks such as Haemaphysalis longicornis and Ixodes persulcatus.^[5] The primary mode of transmission occurs through the bite of an infected tick, where Anaplasma bacteria are released into the host via salivary secretions during feeding.^[71] Transmission can rarely occur through blood transfusions from infected donors, as documented in cases of A. phagocytophilum.^[72] Mechanical transmission by biting flies, such as horse flies (Tabanidae) and stable flies (Stomoxys), is documented for some species like A. marginale, though it is not the primary mode for most Anaplasma species; contaminated needles or surgical instruments can also facilitate iatrogenic spread in veterinary settings.^[73] Vector competence involves bacterial multiplication initially in the tick's midgut epithelial cells after acquisition, followed by dissemination to the salivary glands for transmission.^[66] This process is temperature-dependent, with optimal replication and migration occurring between 32°C and 37°C, enabling efficient pathogen development during the tick's active feeding periods.^[74] In the vector's life cycle, larvae acquire Anaplasma from infected hosts, molt while maintaining the infection, and transmit as nymphs or adults.^[20]

Geographic Distribution

Anaplasma marginale, the causative agent of bovine anaplasmosis, is endemic in tropical and subtropical regions worldwide, spanning latitudes from approximately 40°N to 32°S, including parts of the Americas, Africa, Australia, southern Europe, and Asia.^[58] In contrast, Anaplasma phagocytophilum, responsible for human granulocytic anaplasmosis (HGA) and related diseases, predominates in temperate zones of North America, Europe, and Asia.^[75] These distributions reflect the bacterium's adaptation to specific ecological niches influenced by host availability and environmental conditions. Regional hotspots for A. phagocytophilum infections include the northeastern and upper midwestern United States, where HGA cases are most frequently reported, as well as areas in Europe associated with high tick activity.^[75] In Europe, prevalence is notable in regions with suitable habitats for transmission. Emerging concerns involve Anaplasma capra, a zoonotic species first identified in northeastern China and now reported in multiple countries across Asia (including Japan and Malaysia), Europe, and Africa.^[76]^[77] Key reservoirs for A. phagocytophilum include small mammals such as rodents, which maintain the pathogen in enzootic cycles.^[78] For A. marginale, cattle and wild bovids serve as primary reservoirs, facilitating persistence in endemic areas. Climate-driven tick range expansions, including northward shifts in Europe, are contributing to the broadening of these distributions.^[79] Incidence of anaplasmosis has risen since 2000, attributed in part to climate change effects on vector habitats, with global prevalence of A. phagocytophilum infections showing over a 41% increase over a 15-year period.^[80] In the United States, approximately 5,000 cases of HGA are reported annually, underscoring the growing public health impact.^[81]

Clinical Aspects

Diseases in Animals

Bovine anaplasmosis, caused by Anaplasma marginale, manifests as a hemolytic disease primarily affecting cattle, with clinical signs including high fever (up to 42°C), progressive anemia, weight loss, lethargy, jaundice, and abortion in pregnant animals.^[58]^[82] In severe cases, particularly in adult cattle over two years old, mortality can reach 30-50% without prompt treatment, while younger calves typically exhibit milder symptoms but still face risks of significant production losses.^[83]^[84] The disease imposes substantial economic burdens on dairy and beef industries, with annual global losses estimated at $300-900 million due to mortality, reduced milk yield, decreased weight gain, and treatment costs.^[85]^[86] Ovine and caprine anaplasmosis, induced by Anaplasma ovis and A. capra, presents milder symptoms compared to bovine forms, including fever, icterus (jaundice), pallor of mucous membranes, anemia, and occasional weight loss or abortion, though infections are often subclinical in small ruminants.^[58]^[87] A. capra, an emerging pathogen, primarily affects goats and sheep with typically mild or asymptomatic infections.^[88] Prevalence is notably high in regions like the Mediterranean basin and Africa, where serological studies report rates of 13.5-89.7% in sheep and goats, driven by tick vectors and favorable environmental conditions for transmission.^[89]^[90] In dogs, Anaplasma platys causes canine infectious cyclic thrombocytopenia, characterized by recurring drops in platelet counts every 1-2 weeks, leading to potential bleeding tendencies such as petechiae, epistaxis, or hematuria, alongside fever, anorexia, and lethargy in symptomatic cases.^[91]^[92] However, many infections remain subclinical, with clinical disease being mild and self-limiting in naturally exposed animals, though severe thrombocytopenia often occurs in acute cases.^[93] Granulocytic anaplasmosis, primarily due to Anaplasma phagocytophilum, affects equines and wildlife, causing fever, depression, limb edema, ataxia, and icterus in horses, often resolving with supportive care but posing risks in naive populations.^[94] In wildlife such as deer, infections lead to fever, rapid pulse, shortness of breath, and coordination loss, contributing to population declines in endemic areas.^[95] Emerging cases have been noted in zoo settings, highlighting the pathogen's broadening host range beyond domestic species.^[58] Overall, Anaplasma infections in animals carry low direct zoonotic potential, though shared tick vectors like Ixodes species facilitate indirect transmission risks to humans.^[96] In regions with high bovine prevalence, vaccination using the live attenuated Anaplasma centrale strain is employed to reduce clinical disease severity and economic impacts, particularly in Australia and parts of Africa.^[97]^[98] In 2024, researchers developed a genetically modified live vaccine that provides protection against A. marginale for at least one month in cattle.^[99]

Diseases in Humans

Human granulocytic anaplasmosis (HGA), primarily caused by Anaplasma phagocytophilum, is an acute febrile illness transmitted to humans via the bite of infected blacklegged ticks (Ixodes scapularis) or western blacklegged ticks (Ixodes pacificus).^[75] Symptoms typically emerge 5–14 days after a tick bite and include fever, headache, malaise, myalgia, chills, and fatigue, often accompanied by laboratory abnormalities such as leukopenia, thrombocytopenia, and elevated liver enzymes.^[100] These nonspecific manifestations can mimic other tick-borne diseases, leading to diagnostic challenges in endemic regions.^[101] Individuals at higher risk for severe HGA include the elderly and those who are immunocompromised, with co-infections such as Lyme disease (Borrelia burgdorferi) or babesiosis (Babesia microti) commonly occurring in overlapping endemic areas due to shared tick vectors.^[100] Animal reservoirs like white-tailed deer and small mammals facilitate human exposure by maintaining the bacterium in natural cycles.^[102] Complications from HGA are uncommon but can involve meningoencephalitis, acute respiratory distress syndrome (ARDS), renal failure, or septic shock, particularly in untreated or vulnerable patients.^[103] The mortality rate is less than 1% with prompt antibiotic treatment, though it rises significantly without intervention, reaching up to 10% in severe cases.^[103] Infections with other Anaplasma species in humans are rare; A. capra has been associated with flu-like symptoms such as fever, headache, malaise, and chills, primarily in China since 2015, while A. platys-like strains have been documented in isolated cases, such as in Venezuela, and no confirmed human infections with A. marginale exist.^[88]^[104] The first human cases of HGA were identified in the United States during the 1990s, initially classified as human granulocytic ehrlichiosis, before taxonomic reclassification renamed the causative agent A. phagocytophilum and the disease HGA in 2001.^[105]

Diagnosis and Management

Diagnostic Methods

Diagnosis of Anaplasma infections primarily relies on laboratory techniques that detect the pathogen directly or indirectly through host immune responses. Microscopy remains a foundational method, involving the examination of Giemsa-stained peripheral blood smears to identify intracytoplasmic morulae, which are clusters of bacteria within host cells such as neutrophils for A. phagocytophilum or erythrocytes for A. marginale.^[42] However, this approach has low sensitivity, ranging from 20% to 80%, particularly in human granulocytic anaplasmosis (HGA), due to the transient and low-level bacteremia, making it more useful in acute phases with high parasitemia but insufficient for routine screening.^[106] Molecular methods, particularly polymerase chain reaction (PCR), offer higher sensitivity and specificity for detecting Anaplasma DNA in blood, tissue, or tick samples. Conventional and real-time PCR assays commonly target conserved genes such as the 16S rRNA, msp2 (major surface protein 2), or groESL, enabling species-specific identification and quantification of bacterial load during acute infection.^[107] Real-time PCR is preferred for its rapid turnaround and ability to distinguish Anaplasma from closely related pathogens like Ehrlichia, with detection limits as low as 1-10 genome copies per reaction in clinical specimens.^[108] Serological tests detect host antibodies against Anaplasma antigens and are valuable for confirming past or ongoing infections, especially in convalescent phases. The indirect immunofluorescence assay (IFA) is the reference standard, where a titer greater than 1:64 for IgG antibodies indicates active or recent infection, often requiring paired acute and convalescent sera to demonstrate a fourfold rise.^[109] Enzyme-linked immunosorbent assay (ELISA) serves as a sensitive screening tool for large-scale surveillance or veterinary applications, detecting IgM and IgG with good specificity but potential cross-reactivity with other tick-borne diseases.^[110] Advanced techniques enhance diagnostic precision for epidemiological and research purposes. Whole-genome sequencing (WGS) allows for strain typing and phylogenetic analysis by comparing full genomic sequences, revealing genetic diversity among Anaplasma isolates from different hosts or regions.^[31] Culture-based isolation, though challenging due to the obligate intracellular nature of the bacteria, can be attempted in specialized cell lines such as HL-60 promyelocytic cells for A. phagocytophilum or tick cell lines like ISE6, but success rates are low and require biosafety level 3 facilities.^[111] Diagnostic challenges include the seasonal nature of infections, peaking in spring and summer due to tick activity, which may delay testing outside endemic periods, and the need to differentiate Anaplasma from ehrlichiosis based on clinical presentation and cell tropism (e.g., neutrophils vs. monocytes).^[112] Combining multiple methods, such as PCR with serology, improves overall accuracy, as no single test achieves 100% sensitivity across all infection stages.^[113]

Treatment and Prevention

The primary treatment for human granulocytic anaplasmosis (HGA) is doxycycline, administered at 100 mg orally twice daily for 10-14 days, which leads to rapid clinical improvement in most cases.^[114] For pregnant individuals or those with contraindications to tetracyclines, rifampin at 300 mg twice daily for 7-10 days serves as an effective alternative, with documented favorable maternal and fetal outcomes in limited reports.^[115] In veterinary medicine, tetracyclines such as oxytetracycline are the first-line antibiotics for anaplasmosis in ruminants, typically given as a single intramuscular injection at 20 mg/kg body weight to reduce parasitemia and support recovery.^[58] Supportive care is crucial for severe cases, particularly in cattle with pronounced anemia, where intravenous fluids help maintain hydration and blood transfusions may partially restore red blood cell volume to prevent collapse.^[58] These measures, combined with antibiotics, improve survival rates in acutely ill animals by addressing hemolytic effects.^[116] Prevention strategies emphasize tick control to interrupt transmission. For humans, applying repellents containing DEET to skin and treating clothing with permethrin reduces tick attachment and pathogen exposure in endemic areas.^[117] In livestock, acaricides such as permethrin-based products applied to animals or environmental sprays effectively lower tick populations on pastures.^[118] Vaccination plays a key role in veterinary control, with live attenuated Anaplasma centrale providing partial cross-protection against A. marginale in cattle, reducing clinical disease severity without preventing infection entirely.^[58] No licensed vaccine exists for human anaplasmosis, though experimental approaches targeting adhesins like Asp14 have shown promise in preclinical models for eliciting protective immunity.^[119] Public health efforts include raising awareness of symptoms and risks in tick-endemic regions to promote early seeking of care, alongside screening blood donors for recent tick exposure or symptoms to mitigate transfusion-transmitted cases, despite the lack of FDA-approved tests.^[120] Confirmed transfusion transmissions underscore the need for deferral protocols based on travel or exposure history.^[121] Challenges in management include emerging tetracycline resistance in veterinary Anaplasma strains, which can lead to persistent infections despite treatment and complicate control in herds.^[122] The absence of a human vaccine further limits long-term prevention options.^[123]

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Human Granulocytic Anaplasmosis and Anaplasma phagocytophilum
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[PDF] Ehrlichiosis and Anaplasmosis in Mammals
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Personal protection measures to prevent tick bites in the United States
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Immunization against Anaplasma phagocytophilum Adhesin Binding ...
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Ehrlichiosis and Anaplasmosis among Transfusion and Transplant ...
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Failure to Eliminate Persistent Anaplasma marginale Infection ... - NIH
Nov 20, 2021 · Oxytetracycline (OTC) and chlortetracycline (CTC) are indicated for treatment [17] and control [18] of anaplasmosis, respectively. Currently, ...
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VirB10 vaccination for protection against Anaplasma phagocytophilum
Dec 18, 2018 · Currently there are no vaccines available against HGA. Conserved membrane proteins that are subdominant in Anaplasma species, such as VirB9 and ...Virb10 Induces Cd4 Th1... · Discussion · Methods