Theileria orientalis, previously considered non-pathogenic, has recently been associated with clinical outbreaks of theileriosis in India, posing a significant threat to the dairy industry. This study aimed to determine the prevalence and haplotype diversity of T. orientalis in crossbred cattle in northern Kerala and to unravel the potential associations between haplotypes and clinical disease. Blood samples were collected from 149 crossbred cattle in areas with history of Theileria outbreaks and high tick infestation in northern Kerala and screened by microscopy and molecular methods. Piroplasms were detected in 78 (52.3%) of Giemsa-stained blood smears. Further, conventional PCR targeting ∼776 base pair of the major piroplasm surface protein (MPSP) gene successfully amplified the DNA of T. orientalis in 124 (83.4%) of the samples. Infected adults exhibited macrocytic normochromic anaemia, whereas infected calves had normocytic hypochromic anaemia. Red blood cell count, haematocrit, and haemoglobin levels did not differ significantly between infected and non-infected cattle. However, eosinophil and reticulocyte counts were significantly higher in infected animals (p < 0.001). The positive animals were categorized into four groups (Group I-IV) based on haematological findings, microscopy, and PCR results. Phylogenetic and network analyses of the MPSP gene revealed the presence of genotypes 3, 5, and 7 in the present study, with genotype 5 reported for the first time from Kerala and being the most prevalent (47.05%). A total of 43 distinct haplotypes were identified, with genotype 5 being the most diverse. A distinct age-related distribution of T. orientalis genotypes was observed, with type 7 occurring predominantly in calves and type 5 in adults. However, the genotype 7 generally regarded as a pathogenic was also detected in asymptomatic calves as well as in anaemic animals. Insights into genetic diversity, age- related susceptibility, and host responses are vital for developing effective surveillance, targeted control strategies, and sustainable management of the oriental theileriosis.

