Cattle tick fever (CTF), caused by Anaplasma marginale, Babesia bovis and Babesia bigemina, remains a sanitary and economic challenge for cattle farming in Brazil. Thus, this study evaluated the prevalence, regional distribution, co-infection patterns, and risk factors associated with CTF causative agents in cattle the semi-arid region of Para & iacute;ba, the semi-arid region of Cear & aacute;, and the Tropical Humid region of Para & iacute;ba, Northeast Brazil. Blood samples were collected from 336 cattle, from 60 farms, and analyzed by means of conventional PCR and nested-PCR, while epidemiological data were obtained through questionnaires applied to producers. The overall infection prevalence by at least one pathogen was 82.7% (278/336), with higher rates in the tropical humid region of Para & iacute;ba at 94.8% (109/115), followed by the semi-arid region of Cear & aacute;, with 88.1% (89/101) and the semi-arid region of Para & iacute;ba with 66.6% (80/120). Co-infections were frequent, especially the association between A. marginale and B. bigemina, detected in 23.2% (78/336) of the animals, while triple infections occurred in 15.8% (53/336) and were most frequent in the semi-arid region of Cear & aacute; at 21.8% (22/101). The semi-arid region of Para & iacute;ba had the fewest entirely positive properties (7/20) and the highest number of entirely negative properties (2/20). The tropical humid region of Para & iacute;ba had the highest number of entirely positive properties (17/21), with no properties entirely free of CTF agents. Multivariate analysis identified the presence of horn fly (OR = 7.23; CI 3.05-18.86; 95% CI), needle reuse (OR = 5.8; CI: 2.62-13.90; 95% CI), animal purchase and introduction without quarantine (OR = 5.4; CI: 2.17-14.93; 95% CI), and pasture sharing (OR = 3.21; CI: 1.08-11.25; 95% CI) as risk factors, while beef herds showed lower susceptibility (OR = 0.28; CI: 0.15-0.52; 95% CI). These findings demonstrate that infections by CTF causative agents are endemic but exhibit region-specific epidemiological patterns, reflecting the combined effects of climate and management practices, and localized transmission foci that may be intensified by commercial cattle movement.