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‚√§≈‘™¡“‡π’¬ §◊Õ Àπ÷Ëß„π‚√§∑’Ëμ‘¥μàÕ®“°·¡≈ßæ“À– Ÿà§π∑’Ë ”§—≠∑’Ë ÿ¥‚√§Àπ÷Ëß‚¥¬‚√§ª√ ‘μπ’È¡’ “‡Àμÿ¡“®“°‡™◊ÈÕ≈‘™¡“‡π’¬(Leishmania) À≈“¬ ªï™’ å ÷Ëß à«π„À≠à·≈⫇ªìπ‚√§μ‘¥μàÕ®“° —μ«å Ÿà§π „π§πæ∫«à“ª√ ‘μμà“ß ªï™’Ë åπ—Èπ¡’§«“¡‡°’ˬ«¢âÕß°—∫°“√°àÕ‚√§∑’Ë·μ°μà“ß°—π ‚¥¬æ∫«à“‡™◊ÈÕLeishmania spp. À≈“¬™π‘¥∑”„À⇰‘¥·º≈À≈ÿ¡ ·≈–‡°‘¥‡¡Á¥μÿà¡∑’˺‘«Àπ—ß ¡’‡™◊ÈÕ∫“ß™π‘¥∑’Ë°àÕ‚√§∑’ˇ¬◊ËÕ‡¡◊Õ°·≈–∑”„À⇰‘¥√Õ¬‚√§∑’Ë®¡Ÿ°º‘¥√Ÿª√à“߉ª ·≈–¡’‡™◊ÈÕ∫“ß™π‘¥∑’Ë°àÕ‚√§∑’ËÕ«—¬«–¿“¬„π·≈–‡ªì𠓇Àμÿ¢Õß‚√§visceral leishmaniasis „π§π ÷Ëß∑”„Àâ∂÷ß·°à™’«‘μ „π∫√√¥“ —μ«å‡≈’È¬ß  ÿπ—¢‡ªìπ —μ«å∑’Ë¡’§«“¡ ”§—≠¡“°∑’Ë ÿ¥ ”À√—∫√–∫“¥«‘∑¬“¢Õß‚√§¥—ß°≈à“«  ÿπ—¢‰¡à‡æ’¬ß·μàªÉ«¬‡ªìπ‚√§≈‘™¡“‡π’¬ ·μà “¡“√∂‡ªìπ —μ«å∑’Ë°—°‡°Á∫‚√§ ”À√—∫‡™◊ÈÕ L. infantum ´÷Ë߇ªìπÀπ÷Ëß„π 2 ‡™◊ÈÕ∑’Ë¡’§«“¡ ”§—≠∑’Ë ÿ¥∑’Ë°àÕ‚√§≈‘™-¡“‡π’¬™π‘¥ visceral leishmaniasis „π§π°“√‡°‘¥√Õ¬‚√§∑’˺‘«Àπ—ß ·≈–∫“ߧ√—Èß°“√‡°‘¥‚√§∑’ËÕ«—¬«–¿“¬„π‰¥â¡’√“¬ß“π∫â“߇ªìπ∫“ߧ√—Èß„π —μ«å‡≈’ȬßÀ√◊Õª»ÿ —μ«å √«¡∑—Èß —μ«å‡≈’Ȭß≈Ÿ°¥â«¬π¡∑’ËÕ¬Ÿà „π «π —μ«å·≈–„π —μ«åªÉ“

‚√§≈‘™¡“‡π’¬Leishmaniasis

(cutaneous and visceral)

™◊ËÕÕ◊Ëπ: Kala-azar, Black Fever, Dumdum Fever, Oriental Sore, Tropical Sore, Uta,Chiclero ulcer, Aleppo boi, Pian bois; Espundia

Last Updated: October 2009

○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

 “‡Àμÿ

‚√§≈‘™¡“‡π’¬¡’ “‡Àμÿ®“°°“√μ‘¥‡™◊ÈÕLeishmania À≈“¬ ªï™’ å ´÷Ë߇ªìπª√ ‘μ™π‘¥‚ª√‚μ´—«∑’ËÕ¬Ÿà„π«ß»å (family) Trypanoso-matidae (order Kinetoplastida) ‚¥¬¡’°«à“30  ªï™’ å∑’ˉ¥â√—∫°“√§âπæ∫ ·≈–Õ¬à“ßπâÕ¬20 ™π‘¥∑’Ë°àÕ‚√§„π —μ«å‡≈’Ȭß≈Ÿ°¥â«¬π¡  °ÿ≈Leishmania π—Èπª√–°Õ∫¥â«¬ 2  °ÿ≈¬àÕ¬§◊Õ Leishmania ·≈– Viannia ÷Ëß·¬°®“°°—π‚¥¬Õ“»—¬μ”·Àπàß∑’ˇ™◊ÈÕ‡æ‘Ë¡®”π«π∑’Ë√–∫∫∑“߇¥‘πÕ“À“√¢Õß·¡≈ß∑’ˇªìπæ“À–°“√®”·π°‡™◊ÈÕ Leishmania π—Èπ¡’§«“¡´—∫´âÕπ·≈–„π∫“ß°√≥’¬—߇ªìπ∑’Ë∂°‡∂’¬ß‡™◊ÈÕ∫“ß™π‘¥Õ“®¡’™◊ËÕ¡“°°«à“Àπ÷Ëß™◊ËÕ ·≈–∫“ß™◊ËÕÕ“®‰¡à‰¥â√—∫°“√¬Õ¡√—∫„π∑’Ë ÿ¥

‚√§ visceral leishmaniasis „π§π¡’ “‡ÀμÿÀ≈—°®“° Leishmania donovani(´÷Ëß√«¡∂÷ß L. archibaldi) ·≈– L. infantumÀ√◊Õ L. chagasi ‡™◊ÈÕ L. donovani ‡ªìπ™π‘¥∑’Ë¡’°“√μ‘¥μàÕ√–À«à“ߧπ‡ªìπÀ≈—°(anthroponotic) ‚¥¬μ‘¥®“°ºŸâ∑’ˇªìπ‚Œ μå°—°‡°Á∫‚√§  à«π L. infantum π—Èπ®—¥‡ªìπ‡™◊ÈÕ°àÕ‚√§ —μ«å Ÿà§π ÷Ë߇§¬¡’°“√‡√’¬°™◊ËÕ‡™◊ÈÕπ’È2 ™◊ËÕ §◊Õ L. infantum ´÷Ë߇ªìπ™◊ËÕ∑’ˇ√’¬°„π·∂∫´’°‚≈°μ–«—πÕÕ° (Old World) ·≈–L. chagasi ‡ªìπ™◊ËÕ∑’Ë„™â‡√’¬°°—π„π·∂∫´’°‚≈°μ–«—πμ° (New World) ‚¥¬„πÕ¥’μºŸâ§π

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‡¢â“„®«à“∑—Èß 2 ‡™◊ÈÕπ’ȇªìπ§π≈–™π‘¥°—π ®π¡’°“√»÷°…“æ—π∏ÿ°√√¡¢Õ߇™◊ÈÕ ·≈–‰¥â¡’°“√®—¥°≈ÿà¡„Àâ∑—Èß 2 ‡™◊ÈÕπ’ȇªìπ‡™◊ÈÕ‡æ’¬ß™π‘¥‡¥’¬« ™◊ËÕ«à“ L. infantum Õ¬à“߉√°Áμ“¡ºŸâ‡¢’¬π∫“ß∑à“π·¬âß«à“ L. chagasi §«√‡ªìπ ªï™’ å¬àÕ¬¢Õß L. infantum ¥—ßπ—Èπ®÷߬—ß¡’°“√„™â™◊ËÕ L. chagasi °—π∫àÕ¬„π·∂∫∑«’ªÕ‡¡√‘°“„μâ  ”À√—∫‡™◊ÈÕÕ◊Ëπ∑’Ë “¡“√∂°àÕ‚√§≈‘™¡“‡π’¬„πÕ«—¬«–¿“¬„π‰¥â„π∫“ߧ√—È߉¥â·°à L. tropica ·≈– L. amazonensis´÷Ëß‚¥¬ª°μ‘¡—°°àÕ‚√§∑’˺‘«Àπ—ß πÕ°®“°π’È¡’‡™◊ÈÕÕ’°Àπ÷Ëß™π‘¥´÷Ë߇æ‘Ë߉¥â√—∫°“√§âπæ∫„À¡à„π‰∑¬

‡™◊ÈÕ Leishmania  à«π¡“°¡—°‡ªì𠓇Àμÿ¢Õß‚√§∑“ߺ‘«Àπ—ß (cutaneousleishmaniasis) ‡™◊ÈÕ∑’Ë°àÕ‚√§„π·∂∫‚≈°„À¡à‰¥â·°à L. braziliensis complex ÷Ëߪ√–°Õ∫¥â«¬ L. braziliensis L. panamensis/L. guyanensis L. shawi L. peruviana·≈– L. mexicana complex ÷Ëߪ√–°Õ∫¥â«¬ L. mexicana L. amazonensis,L. venezuelensis √«¡∑—Èß L. lainsoniL. naiffi L. lindenbergi  à«π„π·∂∫‚≈°‡°à“æ∫«à“‡™◊ÈÕ∑’ˇªì𠓇Àμÿ ‰¥â·°à L. tropicaL. major ·≈– L. aethiopica ´÷Ëß®—¥Õ¬Ÿà„π°≈ÿà¡¢Õß L. tropica complex πÕ°®“°π’È∫“ß ‡μ√π¢Õß L. infantum  “¡“√∂‡ªì𠓇Àμÿ¢Õß cutaneous leishmaniasis‚¥¬‰¡à¡’º≈μàÕÕ«—¬«–¿“¬„π‡≈¬ ·μà¡’¢âÕ¬°‡«âπ ”À√—∫ anthroponotic species¢Õ߇™◊ÈÕ L. tropica ‚¥¬æ∫«à“‡™◊ÈÕ∑ÿ°™π‘¥π—Èπ “¡“√∂μ‘¥μàÕ®“° —μ«å Ÿà§π‰¥â ≈—°…≥–√Õ¬‚√§∑’˺‘«Àπ—ß ª√– ‘∑∏‘¿“æ°“√√—°…“·≈–§«“¡‡√Á«„π°“√°“√À“¬¢Õß‚√§ ·≈–ªí®®—¬Õ◊ËπÊ ¢÷Èπ°—∫™π‘¥¢Õ߇™◊ÈÕ ‡™◊ÈÕ à«π„À≠à™π‘¥ Old World ·≈– New World ¡—°∑”

„À⇰‘¥‚√§∑“ߺ‘«Àπ—߇∑à“π—Èπ ·μà‡™◊ÈÕ NewWorld ™π‘¥ L. braziliensis ·≈– L. pana-mensis L. guyanensis  “¡“√∂°àÕ„À⇰‘¥Õ“°“√∑—Èß∑’˺‘«Àπ—ß·≈–∑’ˇ¬◊ËÕ‡¡◊Õ°√à«¡°—∫∑’˺‘«Àπ—߉¥â

‡™◊ÈÕ L. infantum ‡ªìπ‡™◊ÈÕ≈‘™¡“‡π’¬™π‘¥∑’Ë¡’√“¬ß“πæ∫‰¥â∫àÕ¬∑’Ë ÿ¥„π —μ«å‡≈’Ȭ߷μà‡™◊ÈÕ™π‘¥Õ◊Ëπ°Á¡’√“¬ß“π‡™àπ°—𠧫“¡·μ°μà“ߢÕß ªï™’ å∑’Ë°àÕ‚√§∑“ߺ‘«Àπ—ß À√◊Õ∑“ßÕ«—¬«–¿“¬„ππ—Èπ‰¡àª√“°Ø„π —μ«å ¬°μ—«Õ¬à“߇™àπL. infantum ∑”„À⇰‘¥Õ“°“√„π√–∫∫Õ«—¬«–¿“¬„π§π ·μà “¡“√∂‡°‘¥Õ“°“√∑—Èß∑’˺‘«Àπ—ß·≈–Õ«—¬«–¿“¬„π¢Õß ÿπ—¢ ·≈–‡ªì𠓇ÀμÿÀ≈—°¢Õß√Õ¬‚√§∑’˺‘«Àπ—ß„π·¡«·≈–¡â“‡™◊ÈÕ≈‘™¡“‡π’¬∫“ß™π‘¥ “¡“√∂·¬°‰¥â®“° —μ«å‡∑à“π—Èπ·μଗ߉¡àæ∫°“√√“¬ß“π„π§π

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¬°‡«âπ„π·∂∫·Õπμ“√å°μ‘°“ ‡™◊ÈÕ‡À≈à“π’ȇªìπ‚√§ª√–®”∂‘Ëπ„π·∂∫‡¢μ√âÕπ ·≈–‡¢μÕ∫Õÿàπ °“√·æ√à√–∫“¥„π§π¡—°‡°‘¥¢÷Èπ„π·∂∫∑«’·Õø√‘°“ ∫“ß à«π¢Õß∑«’ª‡Õ‡™’¬·≈–·∂∫μ–«—πÕÕ°°≈“ß ·∂∫∑«’ªÕ‡¡√‘°“„μâ·≈–·∂∫‡¡¥‘‡μÕ√å‡√‡π’¬π „π∑«’ª¬ÿ‚√ªπ—Èπæ∫«à“‚√§≈‘™¡“‡π’¬¡’°“√·æ√à°√–®“¬‰ª„π·∂∫‡Àπ◊Õ‡¡◊ËÕ‡∑’¬∫®“°®ÿ¥¥—È߇¥‘¡

°“√·æ√à°√–®“¬¢Õ߇™◊ÈÕ Leishmania·μà≈–™π‘¥ àߺ≈μàÕ√Ÿª·∫∫¢Õß°“√‡°‘¥‚√§„π·μà≈–∑âÕß∑’Ë √«¡∑—Èߧ«“¡√ÿπ·√ߢÕß‚√§‡™◊ÈÕ L. donovani ‡ªì𠓇Àμÿ¢Õß‚√§ visceralleishmaniasis „π·∂∫∑«’ª‡Õ‡™’¬μÕπ„μâ·≈–·Õø√‘°“  à«π‡™◊ÈÕ L. infantum °àÕ‚√§„π·∂∫‡¡¥‘‡μÕ√å‡√‡π’¬π ·∂∫μ–«—πÕÕ°°≈“ß ·∂∫≈–μ‘πÕ‡¡√‘°“ ·≈–∫“ß à«π¢Õß∑«’ª‡Õ‡™’¬ ‚√§≈‘™¡“‡π’¬∑’Ë°àÕ‚√§∑’˺‘«Àπ—ß

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∑’ˇ°‘¥®“°‡™◊ÈÕ L. major æ∫‰¥â„π·∂∫∑«’ª·Õø√‘°“ μ–«—πÕÕ°°≈“ß ·≈–∫“ß à«π¢Õß∑«’ª‡Õ‡™’¬  à«π‡™◊ÈÕ L. tropica æ∫‰¥â∑’Ëμ–«—πÕÕ°°≈“ß ‡¡¥‘‡μÕ√å‡√‡π’¬π·≈–∫“ß à«π¢Õß∑«’ª‡Õ‡™’¬ ·≈–‡™◊ÈÕ L. aethiopicaæ∫‰¥â„π∫“ß à«π¢Õß∑«’ª·Õø√‘°“ ™π‘¥¢Õ߇™◊ÈÕÕ“®‡√’¬°·μ°μà“ß°—π„π´’°‚≈°μ–«—πμ°´÷Ëß°“√‡°‘¥‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ßæ∫‰¥âμ—Èß·μà„π·∂∫‡¡Á° ‘‚°‰ª®π∂÷ß∑«’ªÕ‡¡√‘°“„μâ

 à«π„π∑«’ªÕ‡¡√‘°“‡Àπ◊Õπ—Èπæ∫°“√‡°‘¥‚√§≈‘™¡“‡π’¬‡ªìπÀ¬àÕ¡Ê Õ¬à“ß®”°—¥‚¥¬¡’√“¬ß“π∑’Ë·§π“¥“ ·≈–°“√‡°‘¥‚√§≈‘™¡“‡π’¬„π ÿπ—¢„π À√—∞Õ‡¡√‘°“∑’Ë¡’ “‡Àμÿ®“°‡™◊ÈÕ L.infantum π—Èπ¡’√“¬ß“π«à“‡°‘¥‚√§„π ÿπ—¢æ—π∏ÿå Foxhound ‡ªìπÀ≈—°„π∫“ß√—∞¢Õߪ√–‡∑» ·≈–∫“ß à«π¢Õß·§π“¥“ ¬—߉¡àæ∫§«“¡‡°’ˬ«¢âÕߢÕß°“√‡°‘¥‚√§≈‘™¡“‡π’¬„π§π°—∫ —μ«å∑’Ëμ‘¥‡™◊ÈÕ‡À≈à“π’È πÕ°®“°π’È°“√„À⧫“¡ π„® ”À√—∫‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß∑’Ë¡’√“¬ß“π‡ªìπ§√—Èߧ√“«„π¡πÿ…¬å·≈–„π —μ«åπ—Èπ ¡—°æ∫∑“ßμÕπ„μâ¢Õß à«π°≈“ߢÕß√—∞‡∑Á° —  ´÷Ëß¡’‡™◊ÈÕª√–®”∂‘ËπÕ¬Ÿà (§“¥«à“πà“®–‡ªìπÀπ÷Ëß„π ¡“™‘°¢Õß L. mexicana com-plex)  à«π„πÕÕ ‡μ√‡≈’¬¥Ÿ‡À¡◊Õπ®–ª≈Õ¥®“°‚√§≈‘™¡“‡π’¬®π°√–∑—Ëßªï §.». 2004¡’√“¬ß“π°“√æ∫‡™◊ÈÕ„π®‘ß‚®â μ—« wallabies·≈– —μ«å∑’Ë¡’°√–‡ªÜ“Àπâ“∑âÕßÕ◊ËπÊ „π «π —μ«å¡’√“¬ß“π°“√‡°‘¥‚√§ ®“°°“√π” —μ«å‡¢â“¡“®“°μà“ߪ√–‡∑»„πæ◊Èπ∑’Ë∑’ˉ¡à¡’‚√§≈‘™¡“‡π’¬‡ªìπ‚√§ª√–®”∂‘Ë𠇙◊ÈÕ‡À≈à“π’È ‰¡à “¡“√∂·æ√à°√–®“¬„πª√–‡∑»‡À≈à“π’È ‰¥âÀ“°‰¡à¡’·¡≈ßæ“À–π”‚√§∑’ˇÀ¡“– ¡Õ¬Ÿà„π‡¢μπ—Èπ

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Lutzomyia ÷Ë߇ªìπæ“À–¢Õ߇™◊ÈÕ·∫∫™’«¿“æ(biological vector) ‡™◊ÈÕ·μà≈–™π‘¥π—Èπ®–¡’°“√ª√—∫μ—« ·≈–μ‘¥μàÕ‡¢â“ Ÿà·¡≈ß·μà≈–™π‘¥Õ¬à“ß®”‡æ“– ‚¥¬¡’‡æ’¬ßμ—«‡¡’¬‡∑à“π—Èπ∑’Ë¥Ÿ¥‡≈◊Õ¥‡ªìπÕ“À“√ √‘ÈπΩÕ¬∑√“¬ (sandfly)®–ÕÕ°À“°‘π‡¡◊ËÕÕ“°“»™◊Èπ ‰¡à¡’≈¡À√◊ÕΩπ‚¥¬‡©æ“–„π™à«ß‡™â“μ√Ÿà ¬“¡æ≈∫§Ë” ·≈–°≈“ߧ◊π ·μà°Á “¡“√∂°—¥‚Œ μ剥â„π™à«ß‡«≈“°≈“ß«—πÀ“°∂Ÿ°√∫°«π®“° ‘Ëß¡’™’«‘μ„π∫√‘‡«≥∑’Ë·¡≈ßÀ≈∫´àÕπÕ¬Ÿà ‡™àπ „π‚æ√ß∑’Ë —μ«å¢ÿ¥Õ“»—¬Õ¬Ÿà ‚æ√ßμâπ‰¡â ∂È” ∫â“π ·≈–∑’ËÕ◊ËπÊ ∑’˧àÕπ¢â“߇¬Áπ·≈–™◊Èπ ·¡≈ßπ’È®–∂Ÿ°¥÷ߥŸ¥‰¥â¥â«¬· ß‰ø®÷ßÕ“®‡¢â“¡“„π∑’ËÕ¬ŸàÕ“»—¬„π‡«≈“°≈“ߧ◊π‰¥â ¥Ÿ‡À¡◊Õπ«à“‰¡à¡’°“√μ‘¥μàÕ¢Õ߇™◊ÈÕ≈‘™¡“‡π’¬ºà“π∑“߉¢à¢Õß·¡≈ß(transovarial transmission) ·≈–ª√ ‘μπ’ÈÕ¬Ÿà√Õ¥„π™à«ßƒ¥ŸÀπ“«¿“¬„πμ—«¢Õß —μ«å‡≈’Ȭß≈Ÿ°¥â«¬π¡∑’ËÕ“»—¬„π‡¢μÀ𓫉¥â ‡ÀÁ∫(Dermacentor variabilis ·≈– Rhipicepha-lus sanguineus) ·≈–À¡—¥ ÿπ—¢ “¡“√∂‡ªìπæ“À–π”‚√§·∫∫ mechanical vector  ”À√—∫‡™◊ÈÕπ’È ‰¥â ·μà‡ÀÁ∫·≈–À¡—¥Õ“®‰¡à¡’§«“¡ ”§—≠„π·ßà√–∫“¥«‘∑¬“¢Õß‚√§π’È‚¥¬‡©æ“–„π‡¢μ∑’Ë¡’√‘ÈπΩÕ¬∑√“¬∑’Ëπ”‚√§‰¥â Õ¬à“߉√°Áμ“¡„π‡¢μÕ◊ËπÊ ‡ÀÁ∫·≈–À¡—¥Õ“®¡’§«“¡‡°’ˬ«¢âÕß„π∫“ß°√≥’∑’ˇ°‘¥‰¡à∫àÕ¬π—°‚¥¬¡’°“√μ‘¥μàÕ®“° ÿπ—¢‰ª Ÿà ÿπ—¢

 —μ«å‡≈’Ȭß≈Ÿ°¥â«¬π¡ “¡“√∂μ‘¥‡™◊ÈÕ≈‘™-¡“‡π’¬·∫∫‰¡à· ¥ßÕ“°“√‡ªìπ√–¬–‡«≈“¬“«π“π ·≈–¡—°μ‘¥‡™◊ÈÕ·∫∫‡√◊ÈÕ√—ß·¡â«à“Õ“°“√¢Õß‚√§≈‘™¡“‡π’¬®–À“¬·≈â«  —μ«å∑’Ëμ‘¥‚√§≈‘™¡“‡π’¬·∫∫°÷Ëß· ¥ßÕ“°“√ (subclinical) “¡“√∂∂à“¬∑Õ¥‡™◊ÈÕ Ÿà√‘ÈπΩÕ¬∑√“¬‰¥â ª√ ‘μ™π‘¥π’È “¡“√∂μ‘¥μàÕ‰¥âºà“π∑“ß°“√∂à“¬‡≈◊Õ¥„π§π·≈– ÿπ—¢ ·≈–¡’°“√μ‘¥μàÕºà“π∑“ß√°„π ÿπ—¢ ÀπŸ ·≈–§π‰¥â „π°√≥’‚√§≈‘™¡“‡π’¬

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„π ÿπ—¢ (canine leishmaniasis) ∑’Ë¡’ “‡Àμÿ®“° ‡™◊ÈÕ L. infantum ∫“ߧ√—Èß “¡“√∂μ√«®æ∫‡™◊ÈÕ‰¥â„ππÈ”≈“¬ ªí  “«–  “√§—¥À≈—Ëß®“°‡¬◊ËÕ∫ÿμ“¢“« ·≈–‡≈◊Õ¥ °“√μ‘¥μàÕ®“°°“√º ¡æ—π∏ÿåπ—Èπ “¡“√∂‡°‘¥¢÷Èπ‰¥â„π ÿπ—¢·≈–Õ“®¡’√Ÿª·∫∫°“√μ‘¥μàÕÕ◊ËπÊ ∑’ˇªìπ‰ª‰¥â ¡’√“¬ß“π°“√μ‘¥μàÕ®“° ÿπ—¢ Ÿà ÿπ—¢(horizontal transmission) ‡æ’¬ß‰¡à°’Ë√“¬„π°√≥’∑’ˇ≈’Ȭ߄π∫â“πÀ√◊Õ§Õ°‡¥’¬«°—π ®“°ª√–«—쑧“¥«à“°“√μ‘¥μàÕπà“‡°‘¥®“°°“√μàÕ Ÿâ°—π ·≈–∫“ß√“¬æ∫«à“ “¡“√∂μ‘¥μàÕ‰¥â®“°°“√‡≈’¬·º≈¢Õßμ—«Õ◊Ëπ∑’Ëμ‘¥‡™◊ÈÕÀ√◊Õ°‘π‡≈◊Õ¥∑’Ë¡’‡™◊ÈÕ‡¢â“‰ª °“√ Õ∫ «π°“√√–∫“¥¢Õ߇™◊ÈÕ„π ÿπ—¢ Foxhound „π À√—∞Õ‡¡√‘°“§“¥«à“‡ªìπ°“√μ‘¥‡™◊ÈÕ L. infantum ®“° ÿπ—¢ Ÿà ÿπ—¢‚¥¬μ√ß ∂÷ß·¡â«à“¬—߉¡à‰¥âμ—¥ª√–‡¥Á𧫓¡‡ªìπ‰ª‰¥â„π°“√μ‘¥μàÕºà“π√‘ÈπΩÕ¬∑√“¬·≈–‡ÀÁ∫À¡—¥ÕÕ°‰ª°Áμ“¡ „π∑“ß°≈—∫°—π°“√‡°‘¥‚√§„π§π®“° —μ«å‡≈’Ȭß≈Ÿ°¥â«¬π¡∑’ˇªìπ —μ«åªÉ“∑“ßμÕπ„μâ¢Õß à«π°≈“ߢÕß√—∞‡∑Á°´— §“¥«à“¡’√‘ÈπΩÕ¬∑√“¬‡ªì𠓇Àμÿ§«“¡‡ ’ˬߢÕß°“√μ‘¥μàÕ·∫∫‚¥¬μ√ß®“° ÿπ—¢∑’Ëμ‘¥‡™◊ÈÕ‰ª Ÿà§ππ—Èπ¬—߉¡à‡ªìπ∑’Ë∑√“∫·πà™—¥

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¡πÿ…¬å ·≈– —μ«å‡ªìπ‚Œ μå∑’Ëμ‘¥‡™◊ÈÕ‰¥â‚¥¬∫—߇Ց≠ (accidental host)  ”À√—∫‡™◊ÈÕLeishmania spp. À≈“¬™π‘¥ ÷Ëß¡’«ß™’«‘μÕ¬Ÿà„π —μ«åªÉ“ ·≈–√‘ÈπΩÕ¬∑√“¬ ‡™◊ÈÕ L. in-fantum L. peruviana ·≈–Õ“®¡’™π‘¥Õ◊Ëπ∑’Ë¡’«ß™’«‘μ„π ÿπ—¢ ∑”„Àâ‡æ‘Ë¡§«“¡‡ ’ˬßμàÕ°“√·æ√à√–∫“¥¢Õß‚√§≈‘™¡“‡π’¬ Ÿà§π‰¥â πÕ°®“°π’È —μ«å™π‘¥Õ◊ËπÊ Õ“®‡ªìπ∑’ËÕ¬ŸàÕ“»—¬¢Õ߇™◊ÈÕ·∫∫∑ÿ쑬¿Ÿ¡‘‰¥â (secondary maintenancehost) L. donovani ·≈– L. tropica ‡ªìπ

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‡™◊ÈÕ Leishmania spp. ‰¡à “¡“√∂Õ¬Ÿà√Õ¥‰¥â¿“¬πÕ° ‘Ëß¡’™’«‘μÀ√◊Õ®“°°“√‡æ“–‡≈’Ȭ߇™◊ÈÕ„πÀ≈Õ¥∑¥≈Õß ‡™◊ÈÕ®–∂Ÿ°¶à“‰¥â‚¥¬ 1% ‚´‡¥’¬¡‰Œ‚ª§≈Õ‰√∑å ·≈– 2%°≈Ÿμ“√—≈¥’‰Œ¥å À√◊ÕøÕ√å¡—≈¥’‰Œ¥å ·≈–‡™◊ÈÕ¡’§«“¡‰«√—∫μàÕÕÿ≥À¿Ÿ¡‘ 50-60 Õß»“‡´≈‡ ’¬ 

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·μà‰¡à· ¥ßÕ“°“√‡ªìπ√–¬–‡«≈“¬“«π“π‚¥¬‰¡àª√“°ØÕ“°“√ªÉ«¬ ¡’√“¬ß“π√–¬–øí°μ—« ”À√—∫‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß„π§π∑’ˇ°‘¥®“°‡™◊ÈÕ™π‘¥ New World ‡°‘¥¢÷Èπ¿“¬„π 1-2  —ª¥“Àå À√◊Õπ“π∂÷ßÀ≈“¬‡¥◊Õπ·≈–¡’√–¬–øí°μ—«π“π∂÷ß 3 ªï ”À√—∫°“√μ‘¥‡™◊ÈÕ™π‘¥ Old World  ”À√—∫√–¬–øí°μ—«¢Õß‚√§≈‘™¡“‡π’¬∑’Ë°àÕ‚√§„πÕ«—¬«–¿“¬„πæ∫«à“¡’√–¬–‡«≈“ 10 «—π®π∂÷ßÀ≈“¬ªï ‚¥¬ à«π„À≠à¡—°®–ª√“°ØÕ“°“√¿“¬„π 2-6 ‡¥◊Õπ

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‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß·≈–∑’ËÕ«—¬«–¿“¬„πÀπ—ß ◊Õ∫“߇≈à¡®–®”·π°Õ’°ª√–‡¿∑Àπ÷Ëß §◊Õ‚√§≈‘™¡“‡π’¬∑’ˇ¬◊ËÕ‡¡◊Õ°™—Èπº‘«‡æ‘Ë¡¡“¥â«¬„π¢≥–∑’Ë∫“ß·À≈àßÕâ“ßÕ‘ß®–®—¥‚√§√Ÿª·∫∫π’ȇªìπ à«πÀπ÷ËߢÕß‚√§≈‘™¡“‡π’¬∑’ˇ°‘¥∑’˺‘«Àπ—ß √Ÿª·∫∫¢Õß‚√§·≈–Õ“°“√∑“ߧ≈‘π‘°®–·μ°μà“ß°—π¢÷Èπ°—∫™π‘¥¢Õ߇™◊ÈÕ≈‘™¡“‡π’¬ ·≈–æ∫«à“‡™◊ÈÕ∫“ߧ√—ÈßÕ“®‰¡à· ¥ßÕ“°“√¢Õß‚√§

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‚√§≈‘™¡“‡π’¬∑’Ë°àÕ‚√§∑’˺‘«Àπ—ß(Cutaneous leishmaniasis)

‚√§≈‘™¡“‡π’¬∑’Ë°àÕ‚√§∑’˺‘«Àπ—ßπ—Èπ¡—°¡’√Õ¬‚√§∑’˺‘«Àπ—߇∑à“π—Èπ ·≈–Õ“®¡’√Õ¬‚√§‡¥’¬«À√◊ÕÀ≈“¬√Õ¬‚√§°Á‰¥â ¢÷ÈπÕ¬Ÿà°—∫™π‘¥¢Õ߇™◊ÈÕ ‚¥¬¡’√Õ¬‚√§≈—°…≥–‡ªìπ·º≈À≈ÿ¡μÿà¡πŸπ‡√’¬∫ À√◊Õ‡ªìπ·ºàπ·¢Áß À√◊Õ≈—°…≥–°“√Àπ“μ—«¢Õߺ‘«Àπ—ߧ≈⓬ÀŸ¥ √Õ¬‚√§„π™à«ß·√°∑’˺‘«Àπ—ß∫√‘‡«≥∑’Ë∂Ÿ°√‘ÈπΩÕ¬∑√“¬°—¥¡—°‡ªìπμÿà¡πŸπ (papule) √Õ¬‚√§ à«π„À≠à¡—°‡°‘¥‡©æ“–∑’Ë ·μà∫“ß°√≥’æ∫«à“ª√ ‘μ “¡“√∂·æ√à°√–®“¬ºà“π∑“ß√–∫∫πÈ”‡À≈◊Õß·≈–°àÕ„À⇰‘¥√Õ¬‚√§„À¡à¢÷Èπ¡“∑’Ë∫√‘‡«≥º‘«Àπ—ß À√◊Õ∫“ߧ√—Èßæ∫∑’ˇ¬◊ËÕ‡¡◊Õ° à«πÕ◊ËπÊ¢Õß√à“ß°“¬ ∫“ߧ√—Èßæ∫«à“μàÕ¡πÈ”‡À≈◊Õß„π∫“ß∫√‘‡«≥¢Õß√à“ß°“¬¡’¢π“¥¢¬“¬„À≠à‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß¡—°‰¡à°àÕ„À⇰‘¥Õ“°“√‡®Á∫ª«¥∑’˺‘«Àπ—ß ¬°‡«âπ·μà°√≥’∑’Ë¡’°“√μ‘¥‡™◊ÈÕ·∑√°´âÕπ ·≈–°“√μ‘¥‡™◊ÈÕ„π™àÕßÀŸ √Õ¬‚√§·º≈À≈ÿ¡¡—°®–¡’¢Õ∫‡¢μ∑’˺‘«Àπ—ß™—¥‡®π·≈–‰¡à≈ß≈÷°‰ª∂÷ß™—Èπ„μ⺑«Àπ—ß √Õ¬‚√§∑’˺‘«Àπ—ß à«π„À≠à®–À“¬‰¥â‡Õß Õ¬à“߉√°Áμ“¡§«“¡√«¥‡√Á«„π°“√À“¬¢Õß·º≈®–¢÷Èπ°—∫ ªï™’ å¢Õ߇™◊ÈÕ „π∫“ß°√≥’Õ“®„™â‡«≈“À≈“¬‡¥◊Õπ∂÷ß 1 ªïÀ√◊Õ¡“°°«à“ ∫“ߪ√–‡¿∑®–∑”„À⇰‘¥√Õ¬·º≈‡ªìπ∂“«√ ºŸâªÉ«¬∑’Ëμ‘¥‡™◊ÈÕHIV  “¡“√∂¡’Õ“°“√Õ¬à“ß√ÿπ·√߉¥â·∫∫‰¡àª°μ‘ ·≈–∑”„Àâ‚√§√—°…“‰¥â¬“° °“√„™â¬“ ‡μ’¬√Õ¬¥å À√◊Õ°“√‡°‘¥¿“«–°¥¿Ÿ¡‘§âÿ¡°—πÕ“® àߺ≈„À⇰‘¥‚√§·∫∫√ÿπ·√߉¥â

‚√§≈‘™¡“‡π’¬·∫∫∑’Ë¡’°“√·æ√à°√–®“¬‰ªμ“¡√à“ß°“¬π—Èπæ∫‰¥â¬“° ”À√—∫·∫∫∑’ˇ°‘¥‚√§∑’˺‘«Àπ—ß ·μà L. amazonensis „π·∂∫‚≈° ’°μ–«—πμ°∑”„À⇰‘¥‰¥â ∂÷ß·¡â«à“‡™◊ÈÕ™π‘¥Õ◊ËπÊ Õ“®¡’ à«π√à«¡¥â«¬‰¥â ºŸâªÉ«¬

„π‡¢μ´’°‚≈°μ–«—πÕÕ°°Á “¡“√∂æ∫‰¥â‚¥¬¡—°‡ªìπ„πºŸâ∑’Ë¡’°“√μ‘¥‡™◊ÈÕ HIV √à«¡¥â«¬„π°√≥’∑’Ë¡’°“√·æ√à°√–®“¬¢Õß‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß μÿà¡πŸπ∑’˺‘«Àπ—ß®–‰¡à‡ªìπ·º≈À≈ÿ¡·μà°√–®“¬‰ª∑—Ë«∫πº‘«Àπ—ß √Õ¬‚√§‡À≈à“π’È “¡“√∂∑”„À⇰‘¥§«“¡‡ ’¬À“¬μàÕ‡π◊ÈÕ‡¬◊ËÕ™—Èπ≈÷° ·≈– “¡“√∂§ßÕ¬Ÿà‰¥âμ≈Õ¥‰ª „π∫“ß√“¬æ∫«à“·∫∫∑’Ë¡’°“√·æ√à°√–®“¬π’È ‰¡à “¡“√∂√—°…“‰¥â

√Ÿª·∫∫‚√§≈‘™¡“‡π’¬™π‘¥ Leishmania-sis recidivans (lupoid leishmaniasis) ‡ªìπ√Ÿª·∫∫∑’Ëæ∫‰¥âπâÕ¬ ¡’≈—°…≥–§◊Õ ¡’°“√æ—≤π“¢Õß√Õ¬‚√§„À¡à∑’Ë¢Õ∫º‘«Àπ—ß∑’ËÀ“¬·≈⫇™◊ÈÕ L. tropica À√◊Õ L. braziliensis ¡—°‡ªì𠓇Àμÿ„À⇰‘¥√Õ¬‚√§‡™àππ’È´÷Ë߉¡à “¡“√∂À“¬‰¥â‡ÕßÀ“°‰¡à¡’°“√√—°…“

‚√§≈‘™¡“‡π’¬∑’Ë°àÕ‚√§∑’ˇ¬◊ËÕ‡¡◊Õ°º‘«Àπ—ß(mucocutaneous leishmaniasis À√◊Õespundia) ¡—°‡°‘¥¢÷Èπ„π·∂∫≈–μ‘πÕ‡¡√‘°“´÷Ëß¡’ “‡Àμÿ®“° L. braziliensis braziliensis·≈– “¡“√∂æ∫‰¥â∫â“ß®“° L. panamensis/L. guyanensis ‚√§≈‘™¡“‡π’¬·∫∫¥—ß°≈à“«¡’·π«‚πâ¡∑’Ë®–‡°‘¥¢÷ÈπÀ≈—ß®“°¡’°“√À“¬®“°‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß∑’ˇ°‘¥®“°‡™◊ÈÕ‡À≈à“π’È·≈â« 1-5 ªï ·μàÕ“®æ∫‰¥â¢≥–∑’ˬ—ß¡’√Õ¬‚√§∑’˺‘«Àπ—ßÕ¬Ÿà Õ“°“√‡√‘Ë¡·√°π—Èπ®–æ∫°“√·¥ß·≈–·º≈À≈ÿ¡∑’Ë™àÕß®¡Ÿ° μàÕ¡“æ∫°“√Õ—°‡ ∫∑’Ë¡’°“√‡ ’¬À“¬¢Õ߇π◊ÈÕ‡¬◊ËÕ∫√‘‡«≥·ºàπ°—Èπ®¡Ÿ° ∫“ß°√≥’Õ“®æ∫∑’˧ÕÀÕ¬·≈–°≈àÕ߇ ’¬ß Õ“°“√‡√‘Ë¡·√°Õ“®æ∫«à“¡’‡≈◊Õ¥°”‡¥“ÕÕ°∫àÕ¬„π™à«ß·√°¢Õß°“√‡°‘¥‚√§ °“√Õ—°‡ ∫Õ“®∑”„Àâ·ºàπ‡¬◊ËÕ°—Èπ®¡Ÿ°∑–≈ÿ ·≈–‡ªì𠓇Àμÿ„Àâ¡’„∫Àπ⓺‘¥√Ÿª‰ªÀ√◊ÕÕÿ¥μ—π§ÕÀÕ¬·≈–°≈àÕ߇ ’¬ß‰¥â „π∫“ß√“¬Õ«—¬«– ◊∫æ—π∏ÿåÕ“®¡’ à«π‡°’ˬ«¢âÕß

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¥â«¬ mucocutaneous leishmaniasis ‰¡à “¡“√∂À“¬‡Õ߉¥â

‚√§≈‘™¡“‡π’¬∑’ËÕ«—¬«–¿“¬„π(Visceral leishmaniasis)

‚√§≈‘™¡“‡π’¬∑’ËÕ«—¬«–¿“¬„ππ—Èπ¡—°‡°‘¥Õ¬à“ߧàÕ¬‡ªìπ§àÕ¬‰ª ·μàÕ—πμ√“¬·≈–‡√◊ÈÕ√—ß ”À√—∫ºŸâ∑’ËÕ“»—¬„πæ◊Èπ∑’Ë∑’Ë¡’ ‚√§π’ȇªìπ‚√§ª√–®”∂‘Ëπ Õ¬à“߉√°Áμ“¡ Õ“°“√¢Õß‚√§π’ÈÕ“®‡°‘¥Õ¬à“߇©’¬∫æ≈—π„ππ—°∑àÕ߇∑’ˬ«∑’Ë¡“®“°æ◊Èπ∑’Ë∑’˪√“»®“°‚√§π’È „π∫“ß°√≥’ (‚¥¬‡©æ“–„π·∂∫∑«’ª·Õø√‘°“) æ∫«à“„π™à«ß·√°®–‡°‘¥≈—°…≥–·°√πŸ‚≈¡“ (granuloma)∑’Ë∫√‘‡«≥º‘«Àπ—ß°àÕπ∑’Ë®–¡’Õ“°“√∑“ß√–∫∫Õ“°“√¢Õß‚√§ visceral leishmaniasis ∑’Ëæ∫‰¥â∫àÕ¬ ‰¥â·°à °“√¡’‰¢â¢÷ÈπÊ ≈ßÊ ‡ªìπ√–¬–‡«≈“π“π πÈ”Àπ—°≈¥ Õ¬“°Õ“À“√πâÕ¬≈ß¿“«–‚≈À‘μ®“ß ∑âÕß°“ß®“°¡â“¡‚μ·≈–μ—∫‚μ¿“«–‡°≈Á¥‡≈◊Õ¥μË”∑”„Àâ‡≈◊Õ¥‰À≈‰¥âßà“¬·≈–æ∫®ÿ¥‡≈◊Õ¥ÕÕ°À√◊Õ‡ ’¬‡≈◊Õ¥∑’Ë∫√‘‡«≥‡¬◊ËÕ‡¡◊Õ° ·≈–¿“«–‡¡Á¥‡≈◊Õ¥¢“«μË”∑”„Àâ¡’§«“¡‰«√—∫μàÕ°“√μ‘¥‡™◊ÈÕÕ◊Ëπ¡“°¢÷Èπ Õ“°“√Õ◊ËπÊ ∑’Ëæ∫‰¥â ‡™àπ ‰Õ ∑âÕ߇ ’¬‡√◊ÈÕ√—ß º‘«Àπ—ß ’§≈È” μàÕ¡πÈ”‡À≈◊Õߢ¬“¬¢π“¥ ·≈–„πÀ≈“¬‡§ æ∫Õ“°“√¢Õß‚√§‰μ‡√◊ÈÕ√—ß „π√“¬∑’˪ɫ¬‰¡àÀπ—°∑’Ë¡’Õ“°“√‰¡à¡“°π—°Õ“®À“¬®“°°“√ªÉ«¬‰¥â‡Õß „π√“¬∑’ˉ¡à‰¥â√—∫°“√√—°…“ à«π„À≠à®–∑”„Àâ∂÷ß·°à™’«‘μ ‚¥¬¡—°¡’ “‡Àμÿ®“°°“√μ‘¥‡™◊ÈÕÕ◊Ëπ·∑√°´âÕπÀ√◊Õ¿“«–·∑√°´âÕπÕ◊ËπÊ „π°√≥’ºŸâªÉ«¬¡’°“√μ‘¥‡™◊ÈÕHIV √à«¡¥â«¬ Õ“°“√®–‡°‘¥‰¥âÕ¬à“ß√«¥‡√Á«·≈–√ÿπ·√ß¡“°À√◊ÕÕ“®‡ªìπ‡§ ·∫∫∑’ˉ¡à‰¥âæ∫∑—Ë«‰ª ºŸâªÉ«¬∑’ˉ¥â√—∫°“√√—°…“·≈â«®–æ∫«à“¬—ߧߡ’‡™◊ÈÕª√ ‘μ§ßÕ¬Ÿà„π√à“ß°“¬ ·≈– “¡“√∂°≈—∫¡“‡ªìπ‚√§≈‘™¡“‡π’¬‰¥â„À¡àÕ’°§√—ÈßÀ“°ºŸâªÉ«¬¡’¿“«–¿Ÿ¡‘§ÿâ¡°—π∫°æ√àÕß

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°“√‡°‘¥¿“«– post-kala azar dermalleishmaniasis (PKDL)  “¡“√∂‡°‘¥‰¥â°—∫∫“ß√“¬À≈—ß®“°∑’Ë¡’°“√À“¬¢Õß‚√§ visceralleishmaniasis ‡π◊ËÕß®“°°“√μ‘¥‡™◊ÈÕ L. do-novani Õ“°“√∑’Ëæ∫ ‰¥â·°à μÿà¡·¥ß (macu-lopapular À√◊Õ macular À√◊Õ nodularrash) √Õ∫ª“° ´÷Ëß°√–®“¬‰ª∑—Ë«‰¥â „π·∂∫∑«’ª·Õø√‘°“ æ∫ PKDL ‰¥â∫àÕ¬ ‚¥¬¡—°‡°‘¥¢÷Èπ¿“¬„π√–¬–‡«≈“ 6 ‡¥◊Õπ¢Õß°“√‡°‘¥‚√§ visceral leishmaniasis ·≈–Õ“°“√π’È®–À“¬‰ª¿“¬„π 1 ªï·¡â ‰¡à¡’°“√√—°…“ „π‡¢μ‡Õ‡™’¬„μâæ∫¿“«–π’È ‰¥â§àÕπ¢â“߬“°‚¥¬æ∫À≈—ß®“°∑’Ë¡’°“√À“¬¢Õß‚√§≈‘™¡“‡π’¬∑’ËÕ«—¬«–¿“¬„π·≈⫇ªìπ‡«≈“À≈“¬ªï·≈–®”‡ªìπμâÕß¡’°“√√—°…“Õ¬à“߬“«π“π „πÕ‘π‡¥’¬æ∫¿“«–π’Ȫ√–¡“≥ 1-3% ¢ÕߺŸâªÉ«¬∑’ˉ¥â√—∫°“√√—°…“‚√§ visceral leishmaniasis ®πÀ“¬

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‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß “¡“√∂«‘π‘®©—¬‰¥â®“°°“√μ√«®À“ª√ ‘μ‚¥¬μ√ß ‡™àπ °“√¢Ÿ¥º‘«Àπ—ß °“√∑” impression smear À√◊Õ‡°Á∫μ—«Õ¬à“߇π◊ÈÕ‡¬◊ËÕ∑’˺‘«Àπ—ß·≈⫬âÕ¡¥â«¬ ’Giemsa Leishmaûs Wrightûs À√◊Õ ’Õ◊ËπÊ

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‚¥¬√–¬– amastigote ‡ªìπ√–¬–∑’Ëμ√«®À“ßà“¬∑’Ë ÿ¥„π√Õ¬‚√§∑’’ˇæ‘Ë߇°‘¥¢÷Èπ„À¡à À√◊Õ√Õ¬‚√§∑’Ë°”≈—ßμ‘¥‡™◊ÈÕ «‘∏’ Polymerasechain reaction assays (PCR) ¡—°„™â„π°“√«‘π‘®©—¬„πæ◊Èπ∑’Ë∑’Ë¡’Õÿª°√≥åπ’È ‡™◊ÈÕ Leish-mania spp.  “¡“√∂‡æ“–‡≈’Ȭ߉¥â Õ¬à“߉√°Áμ“¡ ‡™◊ÈÕ·μà≈– ªï™’ å “¡“√∂‡®√‘≠‡μ‘∫‚쉥â„πÕ“À“√‡≈’Ȭ߇™◊ÈÕ∫“ß™π‘¥‡∑à“π—Èπ ·≈–‡™◊ÈÕ∫“ß™π‘¥·¬°‡™◊ÈÕ‰¥â¬“°¡“° Õ“À“√‡≈’Ȭ߇™◊ÈÕ∑’ËÕ“®„™â ‰¥â„π™à«ß·√° ‰¥â·°à Novy-MacNeil-Nicole (NMN) medium brain-heartinfusion (BHI) medium Evanûs modifiedTobieûs medium (EMTM) Graceûs me-dium ·≈– Schneiderûs Drosophilamedium °“√©’¥‡™◊ÈÕ„πÀπŸ·Œ¡ ‡μÕ√åÕ“®¡’ª√–‚¬™πå„π°√≥’π’È¡’°“√ªπ‡ªóôÕπ®“°Õ¬à“ßÕ◊Ëπ °“√«‘π‘®©—¬‚√§≈‘™¡“‡π’¬‚¥¬°“√‡≈’Ȭ߇™◊ÈÕ„πÀ≈Õ¥∑¥≈Õß (in vitro) „™â‡«≈“5-30 «—π „π¢≥–∑’Ë°“√©’¥‡™◊ÈÕ‡¢â“„π —μ«åπ—ÈπÕ“®„™â‡«≈“‡ªìπ —ª¥“Àå À√◊ÕÀ≈“¬‡¥◊Õπ °“√®”·π°‡™◊ÈÕ√–¥—∫ ªï™’ å À√◊Õ´—∫ ªï™’ å ·≈–/À√◊Õ ‡μ√π “¡“√∂„™â‡∑§π‘§ PCR DNA hy-bridization kinetoplast DNA restrictionendonuclease analysis ·≈– isoenzymeanalysis À√◊Õ«‘∏’∑“ß¿Ÿ¡‘§ÿâ¡°—π«‘∑¬“‚¥¬„™âmononclonal antibody °“√∑¥ Õ∫ delayedhypersensitivity À√◊Õ‡√’¬°«à“ leishmaniaskin test (Montenegro skin test) ¡’ª√–‚¬™πå„π°“√«‘π‘®©—¬ cutaneous ·≈–mucocutaneous leishmaniasis ·μà¡—°„Àâº≈≈∫„π°√≥’∑’ˇªìπ diffuse cutaneousform ·Õπμ‘∫Õ¥’¡—°∂Ÿ° √â“ßÕÕ°¡“™â“ ·≈–¡’√–¥—∫μË”

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liposomal amphotericin B ·≈– miltefo-sine ¬“ à«π„À≠à∑’Ë„™â√—°…“‚√§≈‘™¡“‡π’¬π—Èπ¡—°„Àâ‚¥¬°“√©’¥ ºŸâªÉ«¬‚√§¿Ÿ¡‘§ÿâ¡°—π∫°æ√àÕß∑’ˇªìπ‚√§≈‘™¡“‡π’¬∑’ËÕ«—¬«–¿“¬„ππ—Èπ¡—°¡’¿“«–¥◊ÈÕ¬“μàÕ°“√√—°…“ ·≈–ºŸâªÉ«¬À≈“¬√“¬‡ªìπ‚√§°”‡√‘∫Õ’°‰¥â

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¡’√“¬ß“π°“√‡°‘¥‚√§≈‘™¡“‡π’¬‡ªìπ∫“ߧ√—Èß„π —μ«åªÉ“·≈– —μ«å„π «π —μ«å√«¡∂÷ß°≈ÿࡉæ√‡¡μ∑’ˉ¡à„™à¡πÿ…¬å bush dog(Speothos venaticus) hoary zorros(Lycalopex vetulus) À¡“ªÉ“ ’‡∑“ (Canislupus) ·≈– maned wolves (Chrysocyonbrachyurus) ·≈–¡’°“√∑¥≈Õß„π ÿπ—¢®‘È߮հ∑’Ë°‘πªŸ (Crab-eating foxes) (Cerdocyonthous) ·≈–„π ÿπ—¢®‘È߮հ·¥ß (Vulpesvulpes ) æ∫«à“· ¥ßÕ“°“√ªÉ«¬ „πÕÕ ‡μ√‡≈’¬æ∫«à“¡’√“¬ß“π°“√‡°‘¥‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß„π®‘ß‚®â wallaroos ·≈–μ—« wallabies (Macropus spp.) ∑’ˇ≈’Ȭ߄π «π —μ«å

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‚√§≈‘™¡“‡π’¬∑’ËÕ«—¬«–¿“¬„π∑’ˇªìπanthroponotic form π—Èπ¡’ “‡Àμÿ®“°L. donovani ‡°‘¥‰¥â„π§π∑ÿ°™à«ßÕ“¬ÿ §π∑’Ë ÿ¢¿“æ·¢Áß·√ß¡—°‰¡à‰«√—∫μàÕ‡™◊ÈÕ L. infantum´÷Ë߇ªì𠓇Àμÿ¢Õß‚√§ —μ«å Ÿà§π æ∫°“√μ‘¥‡™◊ÈÕ·∫∫‰¡à· ¥ßÕ“°“√∑’Ë¡’ “‡Àμÿ®“°‡™◊ÈÕπ’È ‰¥â∫àÕ¬·≈–°“√ªÉ«¬¡’·π«‚π⡇°‘¥¢÷Èπ„π‡¥Á°‡≈Á°‡ªìπÀ≈—° À√◊Õ„π§π∑’Ë¢“¥ “√Õ“À“√À√◊Õ¡’¿“«–¿Ÿ¡‘§âÿ¡°—π∫°æ√àÕß Õ—μ√“°“√쓬¢ÕߺâŸ∑’ˉ¡à‰¥â√—∫°“√√—°…“ Ÿß∂÷ß 75-95% ·≈–ª√ ‘μπ—ÈπÕ“®§ßÕ¬Ÿà„π√à“ß°“¬‰¥â·¡âºŸâªÉ«¬¡’°“√À“¬®“°‚√§≈‘™¡“‡π’¬·≈â«°Áμ“¡ ·≈– “¡“√∂°”‡√‘∫„À¡àÕ’°§√—È ßÀ“°ºâŸπ—Èπ¡’¿Ÿ¡‘§ÿâ¡°—π∫°æ√àÕß¿“¬À≈—ß æ∫«à“ºŸâªÉ«¬∑’Ëμ‘¥‡™◊ÈÕ HIV ª√–¡“≥§√÷ËßÀπ÷Ëß¡—°¡’°“√°”‡√‘∫¢Õß‚√§≈‘™¡“‡π’¬„À¡àÕ’°¿“¬„π 1 ‡¥◊Õπ∂÷ß3 ªï∂—¥¡“·¡â«à“®–¡’°“√√—°…“∑’Ë¥’·≈â«°Áμ“¡

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 —μ«å∑’ˇªìπ‚Œ μå°—°‡°Á∫‚√§ ”À√—∫‡™◊ÈÕ≈‘™¡“‡π’¬™π‘¥‚≈°‡°à“∑’ˇªì𠓇Àμÿ¢Õß‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß ‰¥â·°à ‡®Õ√å∫‘≈ girds·≈– —μ«åøíπ·∑–  ”À√—∫‡™◊ÈÕ L. major ·≈– —μ«å„π°≈ÿà¡ Hyracoideas (hyraxes)  ”À√—∫‡™◊ÈÕ L. aethiopica  ”À√—∫‡™◊ÈÕ≈‘™¡“‡π’¬™π‘¥‚≈°„À¡à∑’ˇªì𠓇Àμÿ¢Õß‚√§≈‘™¡“‡π’¬∑’˺‘«Àπ—ß ¡—°¡’ —μ«å∑’ËÕ“»—¬„πªÉ“‡ªìπ‚Œ μå°—°‡°Á∫‚√§  —μ«å∑’ˇªìπ‚Œ μå°—°‡°Á∫‡™◊ÈÕ L.braziliensis π—Èπ¬—߉¡à‡ªìπ∑’Ë∑√“∫·πà™—¥Õ¬à“߉√°Áμ“¡ ¡’√“¬ß“π°“√μ‘¥‡™◊ÈÕ≈‘™¡“‡π’¬™π‘¥π’È„π —μ«åÀ≈“¬™π‘¥ ‰¥â·°à  —μ«å°‘π‡π◊ÈÕ —μ«åøíπ·∑– ·≈– perissodactyls √«¡∑—Èß ÿπ—¢ ·¡« ·≈– —μ«åμ√–°Ÿ≈¡â“ ¡’§«“¡‡ªìπ‰ª‰¥â«à“‚Œ μå°—°‡°Á∫‚√§μà“ß™π‘¥®–¡’§«“¡ ”§—≠„π·μà≈–æ◊Èπ∑’Ë·μ°μà“ß°—π‰ª ‚Œ μå°—°‡°Á∫‚√§ ”À√—∫‡™◊ÈÕ≈‘™¡“‡π’¬™π‘¥‚≈°„À¡à ªï™’ åÕ◊Ëπ ‰¥â·°à  ≈Õ∏  ”À√—∫‡™◊ÈÕ L.guyanensis/ L. panamensis μ—«π‘Ë¡(armadillo)  ”À√—∫‡™◊ÈÕ L. naiffi ·≈– —μ«åøíπ·∑– ”À√—∫‡™◊ÈÕ L. mexicana L.amazonensis ·≈– L. lainsoni  —μ«å∑’Ë¡’°√–‡ªÜ“ Àπâ“∑âÕß ‡™àπ Didelphis PhilanderMarmosa Caluromys ·≈– Metachirus·≈– ÿπ—¢®‘È߮հ∑’Ë°‘πªŸ “¡“√∂μ‘¥‡™◊ÈÕ L. ama-zonensis ‰¥â ∂÷ß·¡â¡’§«“¡‡¢â“„®«à“ —μ«å

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