Zoonotic parasitic diseases are infectious parasitic infections that are transmitted from vertebrates, especially livestock and wildlife, to humans. These diseases pose a considerable public health threat, with significant repercussions in multiple areas, including public health, livestock production, and ecological stability. They are a critical area of focus in the prevention and management of global infectious diseases (Kolören and Dubey, 2020; Javed and Alkheraije, 2023). Certain pathogens can cause severe organ damage and even death, such as Cryptosporidiosis, Toxoplasma gondii and Echinococcus granulosus, imposing an especially severe burden on underdeveloped countries with limited health infrastructure (Tenter et al., 2001; Ramirez et al., 2004; Malik et al., 2024). These diseases have resulted in considerable economic setbacks for the global livestock sector, leading to reduced productivity and interruptions in supply chains. Additionally, they disturb the ecological balance between parasites and their hosts. Furthermore, the excessive use of antiparasitic drugs may potentially contribute to the spread of resistance (Ryan et al., 2016).

Cystic echinococcosis (CE) is a prevalent zoonotic parasitic disease resulting from the larval stage of Echinococcus granulosus (E. granulosus). It is estimated that there are around 200,000 new cases globally each year, which poses a considerable public health concern, particularly in pastoral areas (Xiao et al., 2013; Borhani et al., 2024; Hogea et al., 2024). The Ganze Tibetan Autonomous Prefecture (30.05°N, 101.96°E), a high-altitude (avg. 3,500m) region in western Sichuan Province, China, sustains a predominantly Tibetan pastoral population of ~1.1 million. This area has emerged as a hyperendemic focus for CE due to three synergistic factors: (1) high-altitude pastoral ecosystems that perpetuate E. granulosus transmission cycles between livestock and domestic dogs; (2) cultural practices such as domestic slaughtering and the ritualistic disposal of contaminated offal contribute to ongoing environmental pollution; (3) systemic challenges in veterinary service coverage and public health infrastructure that limit zoonotic disease control. These determinants collectively sustain one of China’s highest CE burdens, with reported community prevalences exceeding 10% in adjacent Tibetan areas (Wang et al., 2014; Alvi et al., 2021; Hua et al., 2022).

The ongoing endemicity of CE in Tibetan communities poses a significant threat to the health of local herders and exacerbates clinical outcomes due to delays in diagnosis (Fu et al., 2021; Xu et al., 2025). While current diagnostic standards require multimodal integration of (1) epidemiological risk assessment; (2) clinical evaluation of organ-specific manifestations; (3) imaging confirmation (ultrasonography following WHO-IWGE classification and CT/MRI); and (4) serological testing (IgG ELISA with immunoblotting confirmation), resource limitations in underserved regions critically constrain implementation (Santucciu et al., 2020; Tamarozzi et al., 2021). In these settings, blood biochemical and serological tests are essential for early detection and monitoring of the disease, primarily due to their non-invasive nature, cost-effectiveness, and accessibility. Nevertheless, several challenges hinder the effectiveness of traditional serological assays, including intricate immune responses characterized by dynamic antibody profiles and antigenic diversity, high prevalence of co-infections with other parasites such as alveolar CE and cysticercosis, and logistical difficulties in sample collection and preservation in resource-poor conditions, which critically affect the practicality of these tests (Wang et al., 2008; Li et al., 2020).

The majority of current diagnostic studies on CE have primarily concentrated on regions with improved sanitation, with limited attention given to the distinct challenges posed pastoral ecosystems in economically disadvantaged settings (Sayek et al., 2004; Tao et al., 2024). This study systematically evaluates serological and biochemical markers in CE patients from the Ganze Prefecture, aiming to (1) assess the diagnostic performance of key laboratory indicators; and (2) develop an optimized, cost-effective multi-parameter diagnostic framework tailored to resource-limited regions (Rinaldi et al., 2014; Tamarozzi et al., 2014). By integrating region-specific epidemiological and clinical data, our findings could improve early CE detection and inform targeted control strategies in similar endemic zones (Nunnari et al., 2012; Govindasamy et al., 2023).

This research investigated the relationship between hematological and biochemical parameters in the Tibetan population and cystic echinococcosis (CE), uncovering significant laboratory indicators that offer essential data for the prevention and diagnosis of cystic echinococcosis. CE can induce abnormalities in routine blood and biochemical indicators. Hematological analysis revealed increased abnormality rates in red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), and mean corpuscular volume (MCV), with all these parameters showing significantly lower concentrations compared to the normal control group. These findings collectively reflect reduced hemoglobin levels, suggesting impaired oxygen-carrying capacity (Klisic et al., 2023; Wen et al., 2024). The simultaneous decline in these markers may indicate chronic inflammation in CE patients, leading to accelerated erythrocyte destruction, compromised oxygen transport, and subsequent tissue hypoxia, which could result in neurological dysfunction or severe respiratory/circulatory impairment. Alternatively, these abnormalities may signal anemia, warranting clinical vigilance.

Thrombocytosis, another observed abnormality, poses additional health risks by potentially elevating thrombotic susceptibility, as platelets primarily function in hemostasis and thrombosis prevention (Teodorico et al., 2024). However, excessive platelet (PLT) counts may promote unwanted intravascular clot formation, increasing the risk of thrombotic disorders such as myocardial infarction or stroke. While CE itself already compromises patient health, concomitant thrombocytosis could further exacerbate these risks. For instance, CE-induced liver or multi-organ damage may synergize with elevated PLT to heighten susceptibility to hemorrhage or thrombosis (Fei et al., 2024).

Serological analyses also revealed significant elevations in EOS% and BAS% among CE patients. Both cell types are pivotal in immune responses, particularly against parasitic infections and allergic reactions (Wang et al., 2023). Their elevation in echinococcal infection suggests immune hyperactivation (Liu et al., 2022). While this exhibits a protective effect, excessive quantities may lead to tissue damage or other complications. ROC curve analysis indicated strong predictive utility for EOS% in CE diagnosis (AUC = 0.72; optimal cutoff: 4.2%). Collectively, these serological aberrations reflect both host anti-parasitic responses and a chronic inflammatory state, which may predispose patients to thrombosis, nutritional deficits, and systemic health decline. Thus, comprehensive CE management should extend beyond primary treatment to include vigilant monitoring and correction of these hematological derangements to optimize clinical outcomes.

Total bilirubin (TBIL), direct bilirubin (DBIL), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) levels are significantly elevated in patients with CE. The significant increase in TBIL, DBIL, and GGT is attributed to the compressive impact of intrahepatic cysts on the bile ducts (Miletic et al., 2024). Elevated levels of GGT and ALP (established markers of cholestasis), along with AST (a marker of hepatocellular injury) provide evidence of compromised liver function. The changes in these secretions and enzymes may be caused by the direct invasion of parasites into liver tissue or by secondary complications. Interestingly, these indicators showed a more pronounced increase in patients with concurrent infections ( Supplementary Table S3 ), suggesting that the presence of concurrent infections exacerbates liver function deterioration.

Notably, we observed significant prolongation of prothrombin time (PT) in CE patients (AUC = 0.969, optimal cutoff >12.2 s). While no direct causal relationship between CE and PT prolongation has been established, our data suggest that this phenomenon reflects secondary hepatic dysfunction, as 91% of affected cases showed imaging-confirmed liver involvement, with the majority concurrently exhibiting abnormal liver enzymes. The mechanistic basis may involve impaired synthesis of vitamin K-dependent coagulation factors (II, VII, IX, and X) due to cystic lesions and associated inflammation, which compromises hepatic synthetic function (Tao et al., 2022). This hypothesis is supported by the strong correlation between PT prolongation and other hepatic injury markers.

The combination of prothrombin time (PT) and eosinophil percentage (EOS%) showed enhanced diagnostic accuracy (AUC = 0.982) in clinical settings, indicating that these biomarkers represent distinct pathological processes: PT reflects liver dysfunction, while EOS% indicates an immune response to parasitic infection. These results suggest that coagulation testing may serve as a useful supplementary diagnostic tool in regions endemic for CE.

Recent studies have indicated a relationship between blood biomarkers and CE. For instance, a study from Iran found that parasite-derived miRNAs, such as egr-miR-71, can be detected early during infection (Habibi et al., 2023). Meanwhile, research from Austria indicated that eosinophil-derived protein (ECP) levels are significantly elevated in populations infected with CE, which aligns with our perspective (Hotz et al., 2022). Additionally, a cohort study conducted in Italy and Turkey identified immune regulatory factors Src and Lyn as being associated with the activity of CE (Fratini et al., 2020). Although there are differences in biomarkers across various regions, common pathophysiological characteristics, chronic inflammation, liver dysfunction, and parasite immune evasion responses are observed following CE infection. The aforementioned biomarker detection methods are complex, costly, and not readily available in routine clinical practice. In contrast, our approach utilizes easily accessible routine hematological parameters (EOS%/PT), making it highly practical in resource-limited settings (Khan et al., 2023; Al-khlifeh et al., 2024).

As a paradigm of zoonotic parasitic disease, cystic echinococcosis (CE) highlights the complex interdependencies among animal reservoirs, environmental determinants, and human infection. The implementation of early diagnostic protocols and targeted prevention strategies against CE carries substantial scientific and public health significance (Abbas et al., 2020; Dubey, 2021; Almuzaini, 2023). Integrating specific biomarkers into existing CE screening and monitoring programs holds promise for significantly enhancing early detection and risk stratification in public health efforts. For example, biomarkers such as EOS% (with an AUC of 0.72) and PT (with an AUC of 0.969) demonstrate strong predictive value for CE diagnosis, respectively, positioning them as cost-effective tools for resource-constrained settings. Moreover, population-level biomarker data can strengthen burden-of-disease assessments, guiding prioritization of resource allocation in endemic regions. Integrating these established biomarkers into the continuous monitoring system can facilitate early prevention, detection, and treatment, ultimately minimizing the health risks and socio-economic consequences associated with zoonotic diseases.

This study identifies basic hematological parameters, specifically prolonged prothrombin time (PT >12.2s) combined with eosinophil percentage, as highly accurate diagnostic biomarkers for cystic echinococcosis (AUC 0.982) in Tibetan pastoral populations. These findings address a critical diagnostic gap in resource-limited endemic areas by demonstrating that routine blood tests can effectively screen for CE where imaging technologies are inaccessible. Although the hospital-based design may affect generalizability, these cost-effective biomarkers provide a practical solution for early CE detection and could significantly enhance diagnostic capacity in comparable endemic regions. Further validation through community-based screening programs is warranted, along with investigation of their potential for monitoring treatment response and disease progression.