Emerging Human Fascioliasis in India: Review of Case Reports, Climate Change Impact, and Geo-Historical Correlation Defining Areas and Seasons of High Infection Risk.

The trematodes Fasciola hepatica and F. gigantica are transmitted by lymnaeid snails and cause fascioliasis in livestock and humans. Human infection is emerging in southern and southeastern Asia. In India, the number of case reports has increased since 1993. This multidisciplinary study analyzes the epidemiological scenario of human infection. The study reviews the total of 55 fascioliasis patients, their characteristics, and geographical distribution. Causes underlying this emergence are assessed by analyzing (i) the climate change suffered by India based on 40-year-data from meteorological stations, and (ii) the geographical fascioliasis hotspots according to archeological-historical records about thousands of years of pack animal movements. The review suggests frequent misdiagnosis of the wide lowland-distributed F. gigantica with F. hepatica and emphasizes the need to obtain anamnesic information about the locality of residence and the infection source. Prevalence appears to be higher in females and in the 30-40-year age group. The time elapsed between symptom onset and diagnosis varied from 10 days to 5 years (mean 9.2 months). Infection was diagnosed by egg finding (in 12 cases), adult finding (28), serology (3), and clinics and image techniques (12). Climate diagrams and the Wb-bs forecast index show higher temperatures favoring the warm condition-preferring main snail vector Radix luteola and a precipitation increase due to fewer rainy days but more days of extreme rainfall, leading to increasing surface water availability and favoring fascioliasis transmission. Climate trends indicate a risk of future increasing fascioliasis emergence, including a seasonal infection risk from June-July to October-November. Geographical zones of high human infection risk defined by archeological-historical analyses concern: (i) the Indo-Gangetic Plains and corridors used by the old Grand Trunk Road and Daksinapatha Road, (ii) northern mountainous areas by connections with the Silk Road and Tea-Horse Road, and (iii) the hinterlands of western and eastern seaport cities involved in the past Maritime Silk Road. Routes and nodes are illustrated, all transhumant-nomadic-pastoralist groups are detailed, and livestock prevalences per state are given. A baseline defining areas and seasons of high infection risk is established for the first time in India. This is henceforth expected to be helpful for physicians, prevention measures, control initiatives, and recommendations for health administration officers.