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. 2026 Jun 15;26:1705. doi: 10.1186/s12879-026-13336-0

Epidemiological characteristics of Echinococcus granulosus infection in children from some sites in Xinjiang and its association with platelets

Hongjie Jiao 1,2, Qi Hao 3, Yu Liu 2, Gang Guo 5, Pengfei Lu 2, Chuanchuan Wu 4, Chuanlong Song 2, Yingbin Yue 2, Wenjing Qi 4, Jun Li 2, Wenbao Zhang 2, Mei Yan 2,6,✉
PMCID: PMC13599249  PMID: 42298459

Abstract

Objective

The aim of this study was to delineate the epidemiological features of echinococcosis in children of patient data collected and to identify any associations between the infection and increased platelet parameters.

Methods

Between 2007 and 2024, we conducted a comprehensive analysis of cases with E.granulosus s.s. infection children aged 0–14 years and analysis blood routine examination results involving with E.granulosus s.s. infection and normal children. A total of 930 children were collected, including 316 infected children and 496 normal children after screening. Data were sourced from the case systems of the First Affiliated Hospital of Xinjiang Medical University and Yili Friendship Hospital. Information on age, gender, ethnicity, residential address, diagnosis, chief complaints, and medical history were collected for both infected and non-infected children. 1:1 matching was carried out when counting platelets and their related indexes. Data abstraction adhered to established guidelines and was independently performed by two reviewers. Quality assessment utilized a critical appraisal checklist for prevalence studies. The study adopted a retrospective design, involving two-center case collection and subsequent data analysis.

Results

In children infected with E.granulosus s.s., gender, age, and ethnicity are not the primary factors influencing platelet counts. Additionally, the main infection sites are predominantly located in the liver. Among the cases analyzed, the proportion of infections in the Yili Kazakh Autonomous Prefecture in northern Xinjiang was higher compared to other regions, suggesting potential inclusion and statistical bias. Before and after propensity score matching, the platelet values in children infected with E.granulosus s.s. were significantly higher than those in healthy children, with statistically significant differences (all P < 0.001). The MPV values in children infected with E.granulosus s.s. were significantly lower than those in healthy children, also with statistically significant differences (all P < 0.001). Prior to propensity score matching, the PCT values in children infected with E.granulosus s.s. were higher than those in healthy children, with a statistically significant difference (P = 0.0201). After propensity score matching, there was no statistically significant difference between the two groups (P = 0.9419). Both before and after propensity score matching, the PDW values in children infected with E.granulosus s.s. were higher than those in healthy children, with statistically significant differences (all P < 0.001).

Conclusions

The collection and analysis of clinical case data revealed the following findings: Firstly, in pediatric cases of E.granulosus s.s. infection, the primary site of infection was predominantly concentrated in the liver. In northern regions of Xinjiang, such as the Yili Kazak Autonomous Prefecture, the infection rate was significantly higher compared to other areas, the proportion of infected children in rural areas is higher than that in urban areas. Secondly, children infected with E.granulosus s.s. exhibited higher platelet counts, lower MPV, and higher PDW compared to healthy children. This indicates that E.granulosus s.s. infection affects platelet parameters.

Keywords: E.granulosus s.s., Platelet, Mean platelet volume, Thrombocytocrit, Platelet distribution width

Introduction

Echinococcosis is a zoonotic parasitic disease caused by the larval stage of Echinococcus granulosus sensu stricto (E.granulosus s.s.), poses a significant global health burden, particularly in pastoral regions such as the Mediterranean Basin, the Middle East, Australia, South America, and western China [1, 2]. Transmission occurs via a definitive host (e.g. dogs) that sheds eggs in feces, contaminating water, vegetation, and soil. Intermediate hosts, including humans, sheep, and cattle, become infected through accidental ingestion of eggs, leading to cyst formation primarily in the liver and lungs, though other organs (e.g. brain, kidneys) may also be affected. The clinical manifestations—abdominal pain, jaundice, respiratory distress, and neurological deficits—arise from mechanical compression by hydatid cysts and inflammatory responses [3, 4].

Although E.granulosus s.s. infection is distributed globally and poses a significant public health issue worldwide, epidemiological studies focusing on children remain insufficient. Most existing literature focuses on the epidemiological characteristics, pathological features, and treatment strategies of adult infections, while there is a lack of systematic reporting on the incidence, gender, ethnicity, and regional differences in E.granulosus s.s. infection among children globally [5]. The demographic characteristics of E.granulosus s.s. infection in children have also not been fully elucidated.

Platelets, anucleate cell fragments derived from megakaryocytes, are traditionally recognized for their role in hemostasis and thrombosis [6]. Upon vascular injury, platelets adhere to exposed subendothelial collagen via glycoprotein receptors (e.g. GPIb-IX-V, GPVI), undergo activation, and secrete mediators (e.g. ADP, thromboxane A2) to amplify aggregation and stabilize clots [7, 8].

Studies have confirmed that platelets are the central hub in the microcirculation-injured tissue-immune inflammation interaction network. Their immunoregulatory function plays a crucial role in various inflammatory pathologies. Platelets exert a protective effect on the parasite burden in children, possibly mediated by activating the innate immune system [9]. Several studies have demonstrated that the secreted antigen B (AgB) protein, produced during infection with Echinococcus granulosus cysts, can promote thrombocytosis via immunomodulatory mechanisms.

Emerging evidence, however, highlights their multifaceted roles in inflammation and immune regulation. Platelets interact dynamically with immune cells through direct contact and soluble factors. For instance: Neutrophil Recruitment: Platelet-derived CXCL4 (PF4) and P-selectin facilitate neutrophil adhesion to endothelial cells, promoting extravasation to infection sites [10]. Immunomodulation: Platelets express PD-L1, which suppresses T-cell activation, and release TGF-β to regulate macrophage polarization [7, 8, 10]. Pathogen Clearance: Antimicrobial peptides (e.g. defensins) and complement receptors on platelets enhance bacterial phagocytosis and immune complex clearance [11]. These functions implicate platelets in diverse pathologies, including atherosclerosis, autoimmune disorders, and cancer metastasis [12, 13].

Recent studies suggest bidirectional interactions between E.granulosus s.s. infection and platelet dynamics, though mechanistic insights remain limited [11, 14, 15]. For example, studies have demonstrated that antigens secreted following infection with Echinococcus granulosus can modulate macrophage polarization via specific signaling pathways, leading to thrombocytosis [11]. Moreover, emerging evidence indicates that platelets—upon interaction with platelet factor 4 (PF4/CXCL4) displayed on Plasmodium-infected erythrocytes—can directly mediate intracellular parasite clearance [14, 15]. Despite preliminary findings, critical knowledge gaps persist: Whether Echinococcosis in children affects platelet values and platelet-related indicators, and what is the specific mechanism, all need our indepth study.

In Xinjiang, the epidemiological profile of echinococcosis exhibits marked regional heterogeneity. The northern region—centered on Ili Prefecture, Tacheng Prefecture, and Bortala Mongol Autonomous Prefecture—constitutes the high-incidence core area, accounting for 63% of all reported cases across the region’s 96 counties and districts. In 2023, Ili Prefecture alone contributed 32.25% of the total provincial case count. In contrast, the southern region—including Kashgar and Hotan Prefectures—represents a low incidence zone [16]. This study initially characterized the epidemiological features of echinococcosis among children in Xinjiang Province, and subsequently examined the association between echinococcosis infection and alterations in platelet counts and related hematological parameters. These findings provide a foundational evidence base for elucidating the underlying pathophysiological mechanisms in future research.

Methods

Study design: This retrospective study was carried out in accordance with the principles outlined in the Declaration of Helsinki.

Data collection: A total of 930 children were collected from 2007 to 2024, including data on 418 E.granulosus s.s. infections and 512 normal children. After screening, 316 children with E.granulosus s.s. infection and 496 normal children were included in the analysis. We conducted a comprehensive data collection from two medical facilities: our hospital’s children center and Yili Friendship Hospital in Yili Kazakh Autonomous Prefecture. The selected children with E.granulosus s.s. infection all presented clinical symptoms, such as weight loss, abdominal discomfort, jaundice, abdominal mass, significant diaphragmatic elevation, dyspnea, and other symptoms during physical examination. The diagnosis of each Echinococcal case was confirmed through medical history, physical signs, serology, ultrasonography, CT, and pathology. Most importantly, all these Echinococcal cases were finally confirmed by surgery. All children were diagnosed with stage III or IV E.granulosus s.s. infection and were prepared for surgical treatment. We recorded the age, gender, ethnicity, residential address, diagnosis, chief complaints, medical history, and platelet parameters (mean platelet volume (MPV), thrombocrit (PCT), platelet distribution width (PDW)) of these children, all of which were the results of the first blood draw at admission.

Throughout the data collection process, we implemented rigorous criteria to ensure the reliability and relevance of the collected information. Specifically:

  1. Exclusion of Other Severe Infections: Data from children with severe infections other than E.granulosus s.s. were excluded: Severe pneumonia, pleural effusion, abdominal infection, urinary tract infection, septic shock, cyst rupture and exudation of cyst fluidand and other complications related to E.granulosus s.s..

  2. Exclusion of Data Before and After Operations: Information related to platelet parameters in children with E.granulosus s.s. infection before and after operations was omitted.

  3. Exclusion of Extreme Values: Medical records with extreme values during the detection process were excluded.

  4. Handling Secondary Visits: In cases of secondary visits, overlapping data was excluded, and new data were collected from those records.

  5. Inclusion and exclusion criteria for the normal control group: The data of children in the control group were obtained from normal physical examinations and comprehensive general examinations conducted at the First Affiliated Hospital of Xinjiang Medical University between 2007 and 2024, and there were no other uncomfortable symptoms. Children with systemic infections identified during physical examinations, as well as those with prior systemic diseases impacting platelet function, were excluded from the study.

Data processing

Among the 418 children infected with E.granulosus s.s. and 512 normal children included, a total of 316 children with E.granulosus s.s. were screened and included according to the inclusion and exclusion criteria. Infected children and 496 normal children; The records should analyze the gender, age, ethnicity, home address, chief complaint, medical history, diagnosis of the children’s first visit, and the platelet values, MPV, PCT and PDW in the blood routine data.

(3) To reduce the possible interference of gender, age, ethnicity, etc. on platelet parameters, Propensity score matching (PSM) was conducted. This study first adopts the Nearest neighbor matching (NNM) method, namely E.granulosus s.s. Infected children sought individuals among normal children who were closest in terms of gender, age, ethnicity, etc. for matching, thus achieving a 1:1 match and improving the balance between the two groups.

(4) After propensity score matching (PSM), 209 children infected with Echinococcus granulosus sensu stricto (E. granulosus s.s.) and 209 healthy children were enrolled in the study, with a 1:1 matching ratio for the two groups. Stratified analyses were subsequently performed by gender, age, and ethnicity. To verify the rationality of the stratification by these three factors, we further assessed the intergroup balance of the PSM-matched cohorts within each respective stratum (gender stratum, age stratum, and ethnicity stratum).

(5) Statistical analysis was conducted on platelets and related parameters collected from children infected with E.granulosus s.s. and normal children before and after propensity score matching, respectively.

Statistical analysis

In our analysis, we conducted statistical evaluations using SPSS 27.0 software. The distribution map of the residence was analyzed using Arcgis 10.8. For each group, we performed a statistical analysis of platelet parameters and related indices. The descriptive statistics, represented as (Inline graphic), were calculated for each dataset. To compare the means between two independent groups, we employed the independent samples t-test. Additionally, in our study, we utilized the chi-square test to analyze the comparison of categorical or classification variables between groups. To determine statistical significance, we set the threshold at a P< 0.05. It’s important to note that all P-values were double-tailed.

Ethical considerations: This study was approved by the Ethical examination and approval report No. 20210226-11 issued by the Ethics Committee of the first affiliated Hospital of Xinjiang Medical University on February 26th, 2021.

Results

Incorporate the general characteristics of children

A total of 418 cases of E.granulosus s.s. infection were collected in this study, covering multiple organ infections such as the liver, lungs, brain, spleen, kidneys, and abdominal and pelvic cavities. Non-E.granulosus s.s. were also included. There were 512 cases in the infection control group. After screening through the inclusion and exclusion criteria, E.granulosus s.s. There were 316 cases of infection and 496 normal children. The gender, age and ethnic distribution characteristics of the infected population in each part are shown in Tables 1 and 2.

Table 1.

Table of general characteristics analysis of included children with E.granulosus s.s. infection children infection and normal children from 2007 and 2024

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Table 2.

Statistical results of general data for E.granulosus s.s. infection children and normal children

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Column percentages within each group; The data in the last column are the results of statistical analysis between E.granulosus s.s. infection and normal children by age, sex and nationality, using chi-square test

The distribution of infection sites in the included cases: The liver was E.granulosus s.s. The most common site of infection was 227 cases, accounting for 71.8% of the total infections. The lungs followed with 63 cases, accounting for 19.9% of the total infections. The combined proportion of infections in the brain, spleen, kidneys and abdominal and pelvic cavities was less than 10%.

Gender and age characteristics: E.granulosus s.s. In infections, the proportion of males was slightly higher than that of females (54.3% vs. 45.7%), while in liver infections, the proportion of males was higher than that of females, and the same trend was observed in lung infections. Among the infections of E.granulosus s.s., children aged 7–14 were the high-risk group (accounting for 64.9% of the total infected children), followed by children aged 3–7 (32.9%), and the infection rate of children under 3 years old was the lowest (2.2%).

Ethnic distribution characteristics: E.granulosus s.s. Among the infections, the Han ethnic group had the highest constituent proportion (34.8%), followed by the Uyghur ethnic group (23.7%), then the Kazakh, Mongolian and Hui ethnic groups, with constituent proportions of (15.8%, 12.3% and 7.9% respectively). Other ethnic groups included the Tibetan, Kyrgyz and Tujia. Accounting for 5.4% of the total infections.

Among the total of 496 normal children after screening, the proportion of males was higher than that of females (60.5% vs. 39.5%). There were 283 cases of children aged 7–14, 163 cases of children aged 3–7 and under 3 years old respectively, accounting for 57.1%, 32.9% and 10.1% of the total number of normal children. Among the included normal children, the Han ethnic group had the highest constituent proportion (250 cases, 62.8%), followed by the Uyghur ethnic group (106 cases, 26.6%), then the Kazakh ethnic group, the Mongolian ethnic group and the Hui ethnic group had 11 cases, 2 cases and 0 cases respectively, with constituent ratios of (2.8%, 0.5% and 0%), and other ethnic groups had 29 cases, accounting for 7.3% of the total infections. As shown in Tables 1 and 2.

By collecting the general data of E.granulosus s.s. infected children and normal children, chi-square tests and P-values were performed on all included children in terms of gender, age and ethnicity. It can be seen that there is no significant difference in gender between children infected with E.granulosus s.s. and normal children (X2 =1.824, P = 0.101); By stratifying the age, the chi-square test analysis of each age group showed significant differences (X2 =18.974, P = 0.000); There were significant differences in chi-square tests among various ethnic groups (X2 =127.64, P = 0.000). As shown in Table 2.

Demographic and epidemiological characteristics of E.granulosus s.s. infection

Analyze and collect the regional distribution of children infected with E.granulosus s.s. E.granulosus s.s. The infected children are mainly distributed in areas such as Urumqi, Yili Kazak Autonomous Prefecture, Altay and Korla. As shown in Fig. 1.

Fig. 1.

Fig. 1

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The picture of E.granulosus s.s. infection children distributed different aera of Xinjiang

Among the collected children with echinococcosis infection, the average age was 8.23 years old. Among the majority of infected children, stratified analysis based on gender, age and ethnicity showed that the majority of children lived in rural areas, and there were statistically significant differences in the number of infections compared with those in urban areas (P < 0.05). As shown in Table 3.

Table 3.

Sociodemographic data of children infected with E.granulosus s.s. (n = 316)

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Percentages in the header are of all E.granulosus s.s. infection children, and in the main body are column percentages within each group; The data in the last column are the results of statistical analysis between rural address and city adress in E.granulosus s.s. infection children. The analysis of the age, gender and nationality analysis using chi-square test

E.granulosus s.s. general data statistics after propensity score matching between infected children and normal children

To eliminate the influence of age, gender and ethnicity on statistics, propensity scores were conducted. E.granulosus s.s. was included after a 1:1 propensity score. There were 209 cases of infected children and 209 cases of normal children respectively. The general data characteristics were: After matching of children infected with E.granulosus s.s., the ratio of male to female was balanced (49.3% for males vs. 50.7% for males); Among the ages of children infected with E.granulosus s.s., the 99 cases of children aged 7 to 14 and 3 to 7 were in a balanced proportion, which was 45.9% vs. 47.4%. However, the proportion of children under 3 years old included was relatively small, with 14 cases, accounting for 6.7% of the total number of infections included. Among the children infected with E.granulosus s.s. included, there were 96 cases of Han ethnicity, 53 cases of Uyghur ethnicity, 22 cases of Kazakh ethnicity, 16 cases of Hui ethnicity, and 22 cases of other ethnic minority groups, accounting for the total included E.granulosus s.s. respectively. The infected children were 45.9%, 25.4%, 10.5%, 7.7% and 10.5%. As shown in Table 4.

Table 4.

Statistical table of general data for E.granulosus s.s. infection children and normal children were after propensity score matching

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Column percentages within each group; the data in the P-value column are the results of statistical analysis between E.granulosus s.s. infection and normal children by age, sex and nationality after propensity score matching, using chi-square test. The last column shows the analysis and matching scores of the data after propensity score matching

After matching the normal children population, the ratio of male to female was balanced, with 48.3% for males vs. 51.7%. There were 40 cases of children under 3 years old, 108 cases of children aged 3 to 7, and 61 cases of children aged 7 to 14, accounting for 19.1%, 51.7%, and 27.2% of the total number of normal children respectively. Among normal children, there were 100 cases of Han ethnicity, 50 cases of Uyghur ethnicity, 9 cases of Kazakh ethnicity, 22 cases of Hui ethnicity, and 28 cases of other ethnic minority groups, accounting for the total E.granulosus s.s. respectively. The infected children were 47.8%, 23.9%, 4.3%, 10.5% and 28%. As shown in Table 4.

After propensity score matching of the general data of children infected with E.granulosus s.s. and normal children collected, chi-square tests and P-values were conducted for the included children in terms of gender, age and ethnicity:

  1. In the gender statistics, there was no significant difference between children infected with E.granulosus s.s. and normal children (X2 =0.038, P = 0.845), indicating a balanced age distribution after matching.

  2. By stratifying the age, the chi-square test analysis of each age group showed significant differences (X2 =20.712, P = 0.001), but the standardized mean difference (SMD) analysis indicated that the SMD of only the group younger than 3 years old was greater than 0.4 (0.48), suggesting insufficient matching in this subgroup. The SMD of the remaining age groups was all < 0.4 (3 to 7 years old: 0.04;) 7 to 14 years old: 0.22), indicating that the age distribution after matching is basically balanced.

  3. By stratifying the ethnic distribution: There was no significant difference in the ethnic composition between the two groups (X2 = 7.288, P = 0.121), and the SMD of each subgroup was less than 0.2 except for the Kazakh group which was greater than 0.4 (0.42), suggesting that the influence of ethnic factors on the research results is controllable. As shown in Table 4.

E.granulosus s.s. analysis of platelets and platelet-related indicators between children infected with E.granulosus and normal children

Among the collected data, statistical analyses were conducted on platelets and platelet-related indicators before and after propensity score matching, whether before or after propensity score matching. The platelet values of infected children were significantly higher than those of normal children. Besides the PCT value, there were also significant differences between the MPV and PDW groups (all P < 0.05). The specific statistical analysis results are described as follows:

Before the propensity score, the platelet values of E.granulosus s.s. infected children and normal children were (337.73 ± 5.595) ×109/L and (307.28 ± 2.796) ×109/L respectively. After comparison, the difference between the two groups was statistically significant (P < 0.001). The MPV values of the two groups were (9.03 ± 0.093) fl. and (9.77 ± 0.044) fl. respectively. After comparison, the difference between the two groups was statistically significant (P < 0.001). The PCT values of the two groups were (0.3737 ± 0.040) % and (0.2986 ± 0.0028) % respectively. After comparison, the difference between the two groups was statistically significant (P = 0.0201). The PDW values of the two groups were (13.665 ± 0.173) % and (11.818 ± 2.629) % respectively. After comparison, the difference between the two groups was statistically significant (P < 0.001). As shown in Table 5.

Table 5.

A comparative analysis of platelets and related parameters in pre- and post-matched E.granulosus s.s. infection children and normal children

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After propensity score, the platelet values of E.granulosus s.s. infected children and normal children were (335.67 ± 6.81) ×109/L and (313.14 ± 4.43) ×109/L respectively. Through comparison, the difference between the two groups was statistically significant (P = 0.0058). The MPV values of the two groups were (8.997 ± 0.11) fl. and (9.588 ± 0.06) fl. respectively. After comparison, the difference between the two groups was statistically significant (P < 0.001). The PCT values of the two groups were (0.2996 ± 0.006) % and (0.3001 ± 0.005) % respectively. After comparison, there was no statistically significant difference between the two groups (P = 0.9419). The PDW values of the two groups were (13.844 ± 0.206) % and (11.759 ± 0.178) % respectively. After comparison, the difference between the two groups was statistically significant (P < 0.001). As shown in Table 5.

Discussion

This study represents the first comprehensive investigation into E.granulosus s.s. infection among children in selected regions of Xinjiang, China. It examines the gender, age, ethnicity, and geographic distribution patterns of infected children and explores the association between infection and platelet parameters, thereby elucidating the potential influence of the immune response pattern on platelet kinetics in pediatric patients.

A total of 316 cases of E.granulosus s.s. infection diagnosed between 2007 and 2024 were included based on predefined inclusion and exclusion criteria. Among these, 288 cases were identified at the First Affiliated Hospital of Xinjiang Medical University, and 28 cases were recorded at the Friendship Hospital of Yili Kazak Autonomous Prefecture. The findings reveal a distinct epidemiological profile of E.granulosus s.s. infection in certain areas of Xinjiang. Epidemiological analysis indicates that the infection rate in northern Xinjiang is significantly higher than in other regions, a trend consistent with that observed in adult populations [17]. This may be attributed to several factors: (1) Ecological factors: high densities of dogs as definitive hosts in pastoral areas combined with extensive breeding of intermediate hosts such as sheep and cattle facilitate the establishment of a complete parasite transmission cycle; (2) Behavioral exposure: children may become infected through accidental ingestion of parasite eggs during participation in family herding activities or contact with contaminated water sources; (3) Disparities in medical resources: limited diagnostic capabilities in remote areas may result in delayed detection and underreporting of cases [5, 18, 19].

It is noteworthy that although most pediatric patients have household registrations in non-epidemic areas, this phenomenon may be associated with the seasonal migration patterns of their families to pastoral regions [20]. Geographic Information System (GIS) analysis revealed that cases were predominantly clustered in counties and cities within the agricultural-pastoral ecotone adjacent to pastures, suggesting potential cross-regional transmission of parasite eggs via wind, water sources, or animal activities [20]. These findings challenge the conventional dichotomy of “epidemic versus non-epidemic areas” and underscore the necessity of redefining risk zones through environmental surveillance and population mobility analysis.

This study identified that children aged 7 to 14 years represent the primary infected group (accounting for 64.9%), followed by those aged 3 to 7 years (32.9%), which clearly indicates an age-dependent pattern of infection susceptibility in the study population. The predominance of school-age children (7–14 years) in the infected cohort is not an isolated finding; rather, it aligns with the findings reported by Mihai et al. [18], who also observed that children aged 6–15 years constituted the largest proportion of infected individuals in their investigation of parasitic infections in Eastern European communities. This consistency across different geographic regions suggests that the age-related infection pattern may be a universal characteristic of the disease, rather than a coincidence limited to our study setting [5, 21].

Although no statistically significant associations were found between infection rates and gender or ethnicity in our study (P > 0.05), our ethnic specific subgroup analysis indicated a higher prevalence among Han children compared to nomadic ethnic groups such as Uyghur and Kazakh. This subtle discrepancy, though not statistically significant, merits further discussion and can be interpreted from multiple perspectives, with reference to relevant published studies. Firstly, this difference may be partially attributed to variations in healthcare-seeking behaviors between ethnic groups. As local residents of nomadic ethnic groups (Uyghur and Kazakh) often live in remote pastoral areas, they may prefer nearby grassroots medical facilities or traditional medical practitioners when experiencing mild symptoms, rather than seeking diagnosis and treatment at the two research centers where our samples were collected. This leads to underreporting or underdiagnosis of cases in nomadic ethnic groups, resulting in an apparent lower prevalence in our sample.

Secondly, the limited sample size from only two research centers may have introduced selection bias, which could affect the comparison of infection rates between ethnic groups. Our study only recruited participants from two urban medical centers, which may have overrepresented Han children (who account for a larger proportion of the urban population) and underrepresented nomadic ethnic children (who mainly reside in rural or pastoral areas), leading to an overestimation of the prevalence among Han children.

Alternatively, the lack of a significant gender or ethnic association may suggest that infection risk is more closely tied to the universality of exposure behaviors (such as contact with contaminated soil or water) rather than inherent physiological differences related to gender or ethnicity [5, 18]. This is supported by Mihai et al. [5], whose study also found no significant gender difference in infection rates, and proposed that the disease is primarily transmitted through environmental exposure, which is not significantly influenced by gender-specific physiological characteristics. For ethnic differences on parasitic infections in Xinjiang found that the infection rate was not significantly associated with ethnic identity after adjusting for confounding factors such as living environment and hygiene habits, further confirming that environmental and behavioral factors, rather than ethnic origin itself, are the key drivers of infection.

It is worth noting that some studies have reported conflicting findings regarding gender or ethnic associations. Similarly, we found that in Xinjiang a higher infection rate among Kazakh nomads than among Han residents, which may be related to their traditional pastoral lifestyle (such as close contact with livestock and drinking unboiled water), but this study included a larger sample size from pastoral areas, which may have avoided the selection bias present in our study.

The study also found that among infected children, the liver remains the most common site of primary infection, followed by the lungs. This distribution corresponds with the biological behavior of adult worms, which migrate through the portal venous system after oviposition in the intestinal tract of the definitive host [20, 22, 23]. Clinically, imaging modalities such as B-ultrasound and CT revealed that pediatric infections are characterized by pronounced clinical symptoms and rapid disease progression. Hepatic cysts typically present as unilocular, well-defined fluid-filled areas, distinct from the multilocular lesions commonly observed in adults. This difference may stem from the immature immune systems and weaker localized control over parasitic activity in children, resulting in faster disease progression compared to adults [24–27]. Therefore, enhanced diagnosis and monitoring of E.granulosus s.s. infections in children are particularly critical [20, 28, 29].

Currently, the principal diagnostic methods for E.granulosus s.s. infection include serological testing, imaging techniques, and molecular diagnostics. Serological detection involving the combined use of Echinococcus granulosus secreted antigens (e.g. EgAgB) and specific antibodies enhances the sensitivity of early diagnosis. Imaging modalities such as B-ultrasound demonstrate a 92% detection rate for hepatic cysts, while CT is more effective in evaluating pulmonary lesions and complications such as cyst rupture. Molecular diagnosis based on PCR amplification targeting mitochondrial genes (e.g. COX1, NAD1) enables genotype differentiation and is valuable for traceability studies and assessing pediatric infections. To improve diagnostic accuracy and support prognosis evaluation, an integrated application of these diagnostic tools along with continuous disease monitoring is essential [30–32].

In the dataset collected for this study, certain cases were excluded due to the presence of co-infections (e.g. bacterial or viral infections). Clinical symptom analysis and patient history indicate that mixed infections may disrupt host immune homeostasis [33, 34], thereby complicating further research interpretation and discussion.

In this study, platelet parameter data were statistically analyzed using a 1:1 propensity score matching (PSM) method to enhance the reliability of results and minimize potential confounding effects from age, gender, and ethnicity. Due to the conditional nature of PSM, however, some children infected with E.granulosus s.s. could not be matched, which inevitably led to partial information loss and reduced population representativeness. According to previous literature, stratification based on PSM can reduce bias by more than 90% [35]. Therefore, in this study, we further stratified both E.granulosus s.s. infected children and healthy controls by gender, age, and ethnicity prior to matching in order to minimize bias.

Contrary to traditional understanding that parasitic infections typically cause thrombocytopenia, our findings revealed that platelet counts in E.granulosus s.s.-infected children were generally higher than those in the control group. Potential mechanisms underlying this phenomenon may include the following: (1) Compensatory hematopoietic enhancement: Parasite-secreted antigens (e.g. EgAgB) may activate the PI3K/Akt signaling pathway in bone marrow megakaryocytes, thereby promoting platelet production [36, 37]. (2) Regulation of inflammatory mediators: A Th2-dominant cytokine environment or M2-polarized macrophages (e.g., IL-4, IL-13) may inhibit platelet apoptosis and phagocytosis, thus prolonging their circulation time [38, 39]. (3) Altered splenic function: Chronic infection-induced splenic congestion or fibrosis may reduce platelet sequestration within the spleen [40].

Our analysis also showed that MPV was significantly lower in the infected group compared to the control group. This observation may reflect the following pathophysiological processes: (1) Parasitic metabolic products (e.g. lipid components in cyst fluid) may directly suppress megakaryocyte maturation, resulting in smaller newly produced platelets [36, 37]. (2) Persistent low-grade inflammation may lead to activation of platelet surface p-selectin, promoting adhesion to endothelial cells and subsequent clearance via the mononuclear phagocytic system [41]. (3) Transcriptomic profiling suggests that altered gene expression levels might indirectly affect mitochondrial energy metabolism in platelets of infected children, thereby influencing platelet development [42–44].

MPV is a routinely measured parameter obtained through automated hematology analyzers, reflecting the average volume of individual platelets [45]. Despite its availability, clinicians often overlook MPV changes and focus primarily on platelet counts. In fact, MPV alterations are closely associated with infection severity, clinical manifestations, and prognosis. Generally, elevated MPV may indicate increased peripheral platelet consumption or destruction, prompting the bone marrow to produce larger and more numerous platelets. Conversely, decreased MPV may reflect platelet activation and consumption. In cases of thrombocytopenia caused by peripheral destruction, MPV tends to increase, whereas in cases related to bone marrow dysfunction, MPV decreases [46, 47].

This study observed stable platelet distribution width (PDW) but significantly increased PCT in the infected group, indicating a “PDW-PCT dissociation” phenomenon. Possible explanations include: (1) Enhanced bone marrow release: Parasitic infection may stimulate megakaryocytes to mature and release a greater number of uniformly sized platelets [36, 37]. (2) Platelet-endothelial interactions: Components of E.granulosus s.s. cyst fluid may enhance platelet adhesion to endothelial cells, leading to redistribution of the circulating platelet pool [41].

PDW and PCT are important indicators for evaluating platelet morphology and functional dynamics [48, 49]. PDW reflects the variability in platelet size; low values suggest uniformity in platelet volume, while high values indicate heterogeneity. Previous studies have demonstrated that PDW serves as a useful biomarker in conditions such as acute coronary syndrome and small cell lung cancer [49–51]. An elevated PDW may indicate the release of platelets of varying sizes in response to inflammation or consumption. Changes in PCT directly reflect fluctuations in total platelet mass, potentially linked to either enhanced platelet production or accelerated destruction. Increased PCT may signify effective megakaryocyte maturation and platelet formation, whereas a marked decrease—whether primary or secondary—may suggest thrombocytopenia, although other hematological disorders must first be excluded [52, 53]. Additionally, vasoconstriction can influence PCT levels. Upon vascular injury, platelets adhere to subendothelial surfaces via upregulated glycoprotein (GP) expression, promoting aggregation and increasing PCT. This process is essential for understanding platelet behavior during vascular damage [51, 54]. Integrating PDW and PCT with other clinical parameters (e.g. inflammatory markers, liver function indices) may provide deeper insights into their clinical relevance under infectious conditions. Some studies have reported elevated PDW and MPV in sepsis patients, while others found reduced PDW in individuals with chronic obstructive pulmonary disease compared to controls [55, 56]. Our findings align with these observations.

Limitations of the current study should be acknowledged. First, certain laboratory data, such as dynamic cytokine profiles, were not available, limiting our ability to conduct in-depth mechanistic analyses. Second, the majority of cases were collected from two medical centers—the First Affiliated Hospital of Xinjiang Medical University and the Friendship Hospital of Yili Kazak Autonomous Prefecture. Therefore, caution should be exercised when generalizing the conclusions to broader populations.

Conclusion

First, the epidemiological characteristics of children infected with E. granulosus s.s. were analyzed, Second, E.granulosus s.s. infection in children exhibits immune adjustments, with platelet parameters higher than those in non-infected children, significantly reducing the likelihood of platelet reduction-related diseases. However, the specific mechanism requires further exploration. Continued research is crucial to unravel the intricate mechanisms at play.

Acknowledgments

Special and very much thanks to Professor Wenbao Zhang for his support and contribution to this article.

Author contributions

Hongjie Jiao, Qi Hao, Yu Liu and Wenbao Zhang were the principal writers of the proposals and Wenbao Zhang, Mei Yan designed the protocol of investigation and evaluation. Gang Guo, Wenjing Qi, Jun Li coordinated the field survey and data record. Chuanlong Song, Pengfei Lu and Yingbin Yue collected, confirmed the data. Hongjie Jiao and Qi Hao finalised the statistical analysis. Wenbao Zhang and Mei Yan took part in the analyses, interpretation, and critically revised the paper. All authors read and approved the final paper.

Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 82560033). Key Research and Development Project of Xinjiang Uygur Autonomous Region (2024B03038-1), Etiological Exploration and Prognosis Prediction Cohort Study and Application Promotion of Immune Thrombocytopenia in Children (TSYC202301A002), Joint International Research Laboratory of Prevention and Control of Major Diseases in Central Asia, Xinjiang Medical University(JIRL-MDCA-2024-GH4).

Data availability

All datasets generated and analyzed during the current study are included in the article. Original raw data are available from the corresponding author upon reasonable request. Due to the retrospective nature of the study, (full name of IRB) waived the need of obtaining informed consent. The first affiliated Hospital of Xinjiang Medical University Review Board that waived the need to obtain informed consent from the study participants.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethical examination and approval report No. 20210226-11 issued by the Ethics Committee of the first affiliated Hospital of Xinjiang Medical University on February 26th, 2021.I confirm that all research was performed in accordance with relevant regulations. Research involving human research participants I performed in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All datasets generated and analyzed during the current study are included in the article. Original raw data are available from the corresponding author upon reasonable request. Due to the retrospective nature of the study, (full name of IRB) waived the need of obtaining informed consent. The first affiliated Hospital of Xinjiang Medical University Review Board that waived the need to obtain informed consent from the study participants.

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