‚√§μ‘¥‡™◊ÈÕ

Enterohemorrhagic Escherichia coli

‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

™◊ËÕÕ◊Ëπ : Verocytotoxin producing Escherichia coli (VTEC), Shiga toxin produc-

ing Escherichia coli (STEC), Escherichia coli O157:H7

§«“¡ ”§—≠ º—° ·≈–º≈‰¡â∑’˪π‡ªóôÕπ ª√‘¡“≥¢Õ߇™◊ÈÕ

‡™◊ÕÈ Enterohemorrhagic Escherichia ∑’Ë “¡“√∂°àÕ‚√§‰¥âπ—ÈπÕ¬Ÿà „π√–¥—∫μË”¡“°
coli ‡ªìπ à«πÀπ÷ËߢÕ߇™◊ÈÕ E.coli ∑’Ë°àÕ‚√§ ´÷ßË ∑”„À⡧’ «“¡‡ ¬’Ë ßμàÕ°“√‡°‘¥‚√§‰¥â¡“°¢÷πÈ
(pathogenic E.coli) ∑”„À⇰‘¥Õ“°“√∑âÕ߇ ’¬ ‡™◊ÈÕ EHEC „π´’ ‚√°√ÿäªÕ◊Ëπ∑’Ë∑”„À⇰‘¥
À√◊ Õ ≈”‰ â „ À≠à à « π‚§≈ÕπÕ— ° ‡ ∫·∫∫¡’ hemorrhagic colitis ·≈– HUS π—Èπæ∫
‡≈◊Õ¥ÕÕ° (hemorrhagic colitis) „π§π ®”π«π¡“°¢÷Èπ ´÷Ëߪ√–°Õ∫¥â«¬ O26 O91
´÷Ëß∫“ߧ√—Èß¡’°“√æ—≤𓉪‡ªìπ°≈ÿà¡Õ“°“√ O103 O104 O111 O113 O117 O118
‡¡Á¥‡≈◊Õ¥·¥ß·μ° ·≈–‰μ«“¬ (hemolytic O121 O128 ·≈– O145 ∫“ß°≈ÿà¡¢Õ߇™◊ÈÕ
uremic syndrome; HUS) Õ—π‡ªì𠓇Àμÿ ‡À≈à“π’∑È Õ’Ë “®°àÕ‚√§„π§πÕ¬à“ß¡’π¬— ”§—≠ §◊Õ
∑”„À⇰‘¥¿“«–‰μ«“¬Õ¬à“߇©’¬∫æ≈—π„π‡¥Á° EHEC O157:H7 Õ¬à“߉√°Áμ“¡ ‰¡à “¡“√∂
·≈–∑”„Àâ¡°’ “√ªÉ«¬·≈–쓬„πºŸâ „À≠à „πºŸâ ߟ Õ“¬ÿ √–∫ÿ™π‘¥¢Õ߇™◊ÕÈ ‰¥â®“°Õ“À“√‡≈’¬È ߇™◊ÕÈ ∑’Ë„™â
Õ—μ√“°“√쓬¢ÕߺŸªâ «É ¬∑’¡Ë Õ’ “°“√ HUS Õ“® „π°“√·¬°‡™◊ÈÕ πÕ°®“°π’È ‚¥¬∑—Ë«‰ª·≈â«
Ÿß∂÷ß 50% π—∫μ—Èß·μà™à«ßªï æ.». 2523 Àâ Õ ßªØ‘ ∫— μ‘ À ≈“¬·Àà ß ‰¡à ‰¥â ∑”°“√μ√«®
“¡“√∂√–∫ÿ‰¥â«“à “‡Àμÿ¢ÕßÕ“°“√π’¡È “®“° §—¥°√Õ߇™◊ÕÈ ‡μ√πÕ◊πË Ê ∂÷ß·¡â«“à ‡™◊ÕÈ EHEC
‡™◊ÈÕ E. coli O157:H7 (EHEC O157:H7) À≈“¬Ê ™π‘¥®–‰¡à∑”„Àâ —μ«å· ¥ßÕ“°“√
μ—«°—°‡°Á∫‚√§¢Õ߇™◊ÈÕ EHEC O157:H7 §◊Õ ‡¡◊ËÕ¡’°“√μ‘¥‡™◊ÈÕ ·μà ¡“™‘°∑’Ë ‰¡à „™à´’ ‚√°√ÿäª
—μ«å‡§’Ȭ«‡Õ◊ÈÕß ‚¥¬‡©æ“–‚§ ·≈–·°– O157 Õ“®°àÕ„À⇰‘¥‚√§‡°’ˬ«°—∫≈”‰ â „π —μ«å
— μ «å ® –‰¡à · ¥ßÕ“°“√ªÉ « ¬·μà ® –¢— ∫ ‡™◊È Õ Õ“¬ÿπâÕ¬ „π°√–μà“¬π—Èπ‡™◊ÈÕ EHEC O153
ÕÕ°¡“∑“ßÕÿ®®“√– à«π —μ«å™π‘¥Õ◊ËπÊ ∑’Ë ¡’§«“¡‡°’¬Ë «¢âÕß°—∫‚√§∑’§Ë ≈⓬°—∫°≈ÿ¡à Õ“°“√
“¡“√∂°—°‡°Á∫‡™◊ÈÕ‡À≈à“π’È ‰¥â·°à °√–μà“¬ HUS
·≈– ÿ ° √ §πμ‘ ¥ ‡™◊È Õ EHEC O157:H7
‚¥¬°“√ —¡º— ‚¥¬μ√ß°—∫ —μ«å∑’ˇªìπæ“À– “‡Àμÿ
¡— º— Õÿ®®“√– ·≈–‡™◊ÕÈ ·∫§∑’‡√’¬∑’ªË π‡ªóÕô 𠇙◊ÈÕ Escherichia coli ‡ªìπ‡™◊ÈÕ·∫§∑’‡√’¬
„π¥‘π À√◊ÕπÈ” À√◊Õºà“π∑“ß°“√°‘π‡π◊ÈÕ∫¥ ·°√¡≈∫ √Ÿª√à“ß·∑àßÕ¬Ÿà„π«ß»å Enterobac-
∑’Ë ‰¡à °ÿ À√◊Õº≈‘μ¿—≥±åÕπ◊Ë Ê ®“° μ— «å À√◊Õ°‘π teriaceae ‡™◊ÈÕ E. coli à«π„À≠à‡ªìπ‡™◊ÈÕÕ‘ß

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 Õ“»—¬∑’Ëæ∫‰¥â‡ªìπª°μ‘„π≈”‰ â ‡™◊ÈÕ ‡μ√π
∑’Ë°àÕ‚√§π—Èπ®–·¬°ÕÕ°®“°°≈ÿà¡∑’ˇªìπ‡™◊ÈÕ
Õ‘ßÕ“»—¬ (normal flora) ®“°ªí®®—¬°“√°àÕ
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
§«“¡√ÿπ·√ß (virulence factor) ¢Õ߇™◊ÈÕ
‡™àπ¡’°“√ √â“ß “√æ‘… exotoxins ªí®®—¬
°“√°àÕ§«“¡√ÿπ·√ß∑’Ë®”‡æ“– √à«¡°—∫™π‘¥
¢Õß‚√§ “¡“√∂π”¡“„™â‡æ◊ËÕ·¬°‡™◊ÈÕ™π‘¥
∑’Ë°àÕ‚√§ (pathotypes) ‰¥â
‡™◊È Õ verocytotoxigenic (À√◊ Õ
verotoxigenic) E. coli (VTEC) “¡“√∂
√â“ß “√æ‘…∑’ËÕ—πμ√“¬∑”„À⇴≈≈å‡æ“–‡≈’Ȭß
®“°‰μ≈‘߇¢’¬« ·Õø√‘°“ (African green
monkey kidney cells; Vero cells) 쓬‰¥â
·μà ‰¡à‡°‘¥≈—°…≥–π’È „π‡´≈≈å‡æ“–‡≈’Ȭߙπ‘¥
Õ◊πË “√æ‘…¢Õ߇™◊ÕÈ π’È (verocytotoxins) ·∫àß
ÕÕ°‡ªìπ 2 ™π‘¥À≈—° §◊Õ Vt1 ·≈– Vt2
‡™◊ÈÕ VTEC ∑’Ë·¬°‰¥âÕ“® √â“ߢÕß “√æ‘…
‡æ’¬ß 1 À√◊Õ∑—Èß 2 ™π‘¥°Á ‰¥â ‡π◊ËÕß®“° “√æ‘…
¢Õ߇™◊ÈÕπ’È¡’§«“¡§≈⓬§≈÷ß°—∫™‘°“∑ÁÕ°´‘π
(shiga toxins) ∑’Ë √â“ß®“°‡™◊ÈÕ Shigella
dysenteriae ∑”„À⇙◊ÈÕ VTEC ¬—ß∂Ÿ°‡√’¬°
Õ’°™◊ËÕ«à“ shiga toxin-producing E. coli
(STEC)
‡™◊ÕÈ enterohemorrhagic E. coli (EHEC)
§◊Õ ‡™◊ÕÈ VTEC ∑’¡Ë ª’ ®í ®—¬°“√°àÕ§«“¡√ÿπ·√ß
‡æ‘Ë¡¢÷Èπ ∑”„À⇙◊ÈÕ‡À≈à“π’È¡’§«“¡ “¡“√∂„π
°“√∑”„À⇰‘¥Õ“°“√ hemorrhagic colitis
·≈–°≈ÿà ¡ Õ“°“√ HUS „π§π ≈— ° …≥–
”§—≠ª√–°“√Àπ÷ßË ∑’æË ∫‰¥â„π‡™◊ÕÈ EHEC ·μà
‰¡à ‰¥â¡’§«“¡‡©æ“–‡®“–®ßμàÕ‡™◊ÈÕ E. coli
∑—ßÈ À¡¥ §◊Õ §«“¡ “¡“√∂¢Õ߇™◊ÕÈ „π°àÕ√Õ¬‚√§
‚¥¬°“√‡°“–·≈–∑”≈“¬ (attaching and
effacing (A/E) lesions) ‡¬◊ÕË ∫ÿº«‘ ≈”‰ â „π§π
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√Õ¬‚√§π’È®–¡’≈—°…≥–¢Õß°“√‡°“–μ‘¥¢Õß
‡™◊ÈÕ·∫§∑’‡√’¬„°≈â°—∫‡´≈≈凬◊ËÕ∫ÿ·≈–∑”≈“¬
à«π¢Õ߉¡‚§√«‘≈‰≈ (microvilli) ∫√‘‡«≥∑’Ë
‡™◊ÈÕ‡°“–μ‘¥ °“√√–∫ÿ‡™◊ÈÕ EHEC “¡“√∂
∑”‰¥â ‚¥¬°“√μ√«®À“¬’π∫“ßμ—«∑’ˇ°’ˬ«¢âÕß
°—∫°“√‡°‘¥ A/E lesions √à«¡°—∫°“√æ∫
verocytotoxin
´’ ‚√‰∑ªá∑’ˇ°’ˬ«¢âÕß
‡™◊ÈÕ E.coli π—Èπ∂Ÿ°®”·π°´’ ‚√‰∑ªá‚¥¬
Õ“»—¬·Õπ쑇®π O (somatic lipopolysac-
charide) ·Õπ쑇®π H (flagellar) ·≈–
·Õπ쑇®π K (capsular) ´’ ‚√‰∑ªá∑’Ë∑√“∫«à“
‡ªìπ à«πÀπ÷ËߢÕß EHEC ª√–°Õ∫¥â«¬‡™◊ÈÕ
E. coli O157:H7 ‡™◊ÕÈ E. coli °≈ÿ¡à ∑’Ë ‰¡à‡§≈◊ÕË π∑’Ë
O157:H- ·≈– ¡“™‘°¢Õß´’ ‚ √°√ÿä ª Õ◊Ë π Ê
‚¥¬‡©æ“– O26 O103 O111 ·≈– O145
·μà O91 O104 O113 O117 O118 O121
O128 ·≈–Õ◊ËπÊ ‡™◊ÈÕ E. coli O157:H-
¡’§«“¡‡°’¬Ë «¢âÕßÕ¬à“ß„°≈♥‘ °—∫°—∫‡™◊ÕÈ E. coli
O157:H7 ·μà‡™◊ÈÕπ’È ‰¡à ‰¥â‡ªìπ‡æ’¬ß·§à°≈ÿà¡∑’Ë
‰¡à “¡“√∂‡§≈◊ÕË π∑’Ë ‡™◊ÕÈ π’¬È ß— ¡’≈°— …≥–摇»…
√«¡°—π∑—ßÈ øï ‚π‰∑ªá ·≈–§«“¡√ÿπ·√ߢÕ߇™◊ÕÈ
°“√·¬°´’ ‚√‰∑ªá (serotyping) ‡æ’¬ßÕ¬à“ß
‡¥’¬«π—πÈ Õ“®‰¡à‡æ’¬ßæÕ„π°“√√–∫ÿ«“à ‡ªìπ‡™◊ÕÈ
EHEC ·μଗßμâÕß»÷°…“≈—°…≥–ªí®®—¬°“√
°àÕ§«“¡√ÿπ·√ß∑’®Ë ”‡æ“–¢Õ߇™◊ÕÈ ‡À≈à“π’¥È «â ¬
‡™◊ÈÕ E. coli ‡μ√π O157:H7 ∑ÿ°™π‘¥§àÕπ¢â“ß
¡’§≥ ÿ ¡∫—쇑 À¡◊Õπ°—π (homogeneous) ·≈–
‡°◊Õ∫∑—ÈßÀ¡¥¢Õ߇™◊ÈÕ‡À≈à“π’È¡’ªí®®—¬°“√°àÕ
§«“¡√ÿπ·√ß∑’ˇ°’ˬ«¢âÕß hemorrhagic colitis
·≈–°≈ÿ¡à Õ“°“√ HUS ‡™◊ÕÈ „π´’ ‚√‰∑ªáÕπ◊Ë Ê π—πÈ
®–¡’≈°— …≥–μà“ß°—π (heterogeneous) ¡“°°«à“
¬°μ—«Õ¬à“߇™à𠇙◊ÕÈ E. coli „π´’ ‚√°√ÿªä O26
Õ“®¡’¬π’ verocytotoxin ‡æ’¬ß 1 À√◊Õ 2 ™π‘¥
À√◊ÕÕ“®‰¡à¡¬’ π’ π’‡È ≈¬°Á ‰¥â ·≈–¡’‡æ’¬ß§√÷ßË Àπ÷ßË
¢Õ߇™◊ÈÕ E. coli O26 ∑—ÈßÀ¡¥∑’Ë “¡“√∂·¬°
‡™◊ÈÕ‰¥â®“°°“√»÷°…“Àπ÷Ëß¡’¬’π ehx ´÷Ë߇ªìπ
¬’π∑’Ë “¡“√∂æ∫‰¥â∫πæ≈“ ¡‘¥∑’ˇ°’ˬ«¢âÕß
°—∫‡™◊ÈÕ EHEC ‡™◊ÈÕ∑’Ë·μ°μà“ß°—πÕ“®¡’°≈ÿà¡
¢Õßªí ® ®— ¬ °“√°à Õ §«“¡√ÿ π ·√ß∑’Ë · μ°μà “ ß
ÕÕ°‰ª ‡™àπ ¬’π¢Õß°“√°àÕ§«“¡√ÿπ·√ߢÕß
‡™◊ÈÕ EHEC „π´’ ‚√°√ÿäª O26 ·≈– O145
·μ°μà “ ß°— π √«¡∑—È ß μà “ ß®“°‡™◊È Õ EHEC
O157:H7 ¥â«¬ ®“°°“√∑’Ëªí®®—¬∑’Ë°àÕ§«“¡
√ÿπ·√ßÀ≈“¬Ê ™π‘¥ (√«¡∂÷ß verocytotoxin)
Õ¬Ÿà ∫ πæ≈“ ¡‘ ¥ À√◊ Õ „π·∫§‡∑Õ√‘ ‚ Õ‡ø®
(bacteriophages) ¥—ßπ—πÈ ®÷ßÕ“®¡’‡™◊ÕÈ E. coli
‡μ√π„À¡à∑’Ë¡’√Ÿª·∫∫°“√°àÕ‚√§„À¡à ·≈–/
À√◊Õ∑’ˬ“°„π°“√·∫àß°≈ÿà¡‚¥¬„™â√–∫∫¢Õß
ªí®®ÿ∫—π‡°‘¥¢÷Èπ‰¥â
°“√·æ√à°√–®“¬∑“ß¿Ÿ¡‘»“ μ√å
°“√μ‘¥‡™◊ÈÕ EHEC 0157:H7 ‡°‘¥¢÷Èπ
‰¥â∑—Ë«‚≈° ¡’√“¬ß“π°“√μ‘¥‡™◊ÈÕ‰¥â „ π∑ÿ °
∑«’ª¬°‡«âπ·∂∫·Õπμ“√å°μ‘°“ ‡™◊ÈÕ EHEC
Õ◊πË Ê π—πÈ Õ“®æ∫°“√°√–®“¬Õ¬à“ß°«â“ߢ«“ß
§«“¡ ”§—≠¢Õß∫“ß´’ ‚√‰∑ªáÕ“®·μ°μà“ß
°—π„π·μà≈–æ◊Èπ∑’Ë¿Ÿ¡‘»“ μ√å
°“√μ‘¥μàÕ
‡™◊ÈÕ EHEC μ‘¥μàÕ‰¥â ‚¥¬°“√°‘π ‘Ëß∑’Ë¡’
°“√ªπ‡ªóÕô πÕÿ®®“√–∑’¡Ë ‡’ ™◊ÕÈ (fecal-oral route)
°“√μ‘¥μàÕ√–À«à“ß —μ«å‡°‘¥‰¥â ‚¥¬°“√ —¡º—
‚¥¬μ√ß À√◊Õ°“√„™â√“ßπÈ”√à«¡°—π °“√°‘π
Õ“À“√√à«¡°—π ∑ÿàßÀ≠â“∑’Ë¡’°“√ªπ‡ªóôÕπ À√◊Õ
®“° ‘Ëß·«¥≈âÕ¡Õ◊ËπÊ ¡’§«“¡‡ªìπ‰ª‰¥â∑’Ëπ°
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
·≈–·¡≈ß«—π®–‡ªìπæ“À–π”‚√§ „π°“√
∑¥≈ÕßÀπ÷Ëßæ∫«à“‡™◊ÈÕ EHEC O157:H7
μ‘¥μàÕ‰¥â∑“ßÕ“°“»‡¡◊ËÕ¡’√–¬–Àà“ß√–À«à“ß
ÿ°√Õ¬à“ßπâÕ¬ 10 øÿμ ¡’°“√§“¥«à“‡™◊ÈÕªπ
¡“„π≈–ÕÕßÕ“°“»√–À«à “ ß°“√≈â “ ߧհ
‚¥¬„™â · √ߥ— π Ÿ ß „π°“√∑”§«“¡ –Õ“¥
·μàæƒμ‘°√√¡°“√°‘π ·≈–§ÿâ¬À“Õ“À“√°Á‡ªìπ
ªí®®—¬∑’Ë∑”„À⇰‘¥°“√μ‘¥μàÕ‰¥â
‚Œ μå°—°‡°Á∫‚√§ ·≈–√–∫“¥«‘∑¬“Õ“®
À≈“°À≈“¬¢÷ÈπÕ¬Ÿà°—∫™π‘¥¢Õ߇™◊ÈÕ „π —μ«å
‡§’¬È «‡Õ◊ÕÈ ß‚¥¬‡©æ“–‚§·≈–·°–®–‡ªìπ‚Œ μå
°—°‡°Á∫‚√§∑’Ë ”§—≠∑’Ë ÿ¥¢Õ߇™◊ÈÕ EHEC
O157:H7 ‚§ à«ππâÕ¬„πΩŸßÕ“®‡ªìπμ—«¢—∫
‡™◊ÈÕ‰¥â¡“°°«à“ 95% ¢Õ߇™◊ÈÕ∑’Ëæ∫∑—ÈßÀ¡¥
—μ«å‡À≈à“π’È∂Ÿ°‡√’¬°«à“ super-shedders
®–¡’‡™◊ÕÈ Õ“»—¬Õ¬Ÿ∑à ’Ë «à π¢Õß≈”‰ â „À≠à «à π∑⓬
·≈– “¡“√∂§ß°“√μ‘¥‡™◊ÕÈ ‰¥â¬“«π“π°«à“‚§
μ—«Õ◊ËπÊ °“√‡°‘¥ super-shedders Õ“®¬—ß
‡°‘¥‰¥â „π·°– —μ«å∑’Ë ‰¡à „™à ‚Œ μå°—°‡°Á∫‚√§
ª°μ‘¢Õ߇™◊ÕÈ EHEC O157:H7 Õ“®‡ªìπ‚Œ μå
°—°‡°Á∫‚√§≈”¥—∫∑’Ë 2 (secondary reservoirs)
‰¥â®“°°“√μ‘¥μàÕ —¡º— °—∫ —μ«å‡§’Ȭ«‡Õ◊ÈÕß
°“√μ‘¥μàÕ∑“ßÀ≈—°¢Õ߇™◊ÕÈ EHEC O157:H7
¡“ Ÿà § ππ—È π ‡°‘ ¥ ®“°°“√°‘ π Õ“À“√·≈–πÈ”
∑’Ë¡’°“√ªπ‡ªóôÕπ À√◊Õ®“°°“√ —¡º— °—∫ —μ«å
Õÿ®®“√– ·≈–¥‘π∑’Ë¡’°“√ªπ‡ªóôÕπ °“√μ‘¥μàÕ
®“°§π Ÿà§πÕ“®∑”„À⇰‘¥°“√·æ√à°√–®“¬
¢Õß‚√§√–À«à“ß°“√√–∫“¥ Õ¬à“߉√°Áμ“¡
‰¡àæ∫«à“§π‡ªìπ‚Œ μåÀ≈—° (maintenance
host) ¢Õ߇™◊ÈÕπ’È °√≥’ „π§π à«π„À≠à¡—°¡’
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 §«“¡‡°’ˬ«¢âÕß°—∫°“√ —¡º— °—∫‚§∑—Èß‚¥¬μ√ß
·≈–‚¥¬Õâ Õ ¡ ·μà ∫ “ß°√≥’ æ ∫«à “ ¡’ § «“¡
‡°’ˬ«¢âÕß°—∫ —μ«å™π‘¥Õ◊ËπÊ ‰¥â·°à ·°– ·æ–
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
(π¡∑’Ë ‰ ¡à ºà “ π°“√æ“ ‡®Õ√å ‰ √´å ) ÿ ° √
(´“≈“¡’·Àâß) °«“ß (‡π◊ÕÈ °«“ß) ¡â“ °√–μà“¬
·≈–π° ‚¥¬ª√‘¡“≥¢Õ߇™◊ÈÕ∑’∑Ë ”„À⇰‘¥‚√§
„π§ππ—Èπª√–¡“≥‰¡à‡°‘π 100 μ—« ·≈–Õ“®
¡’‡æ’¬ß‡≈Á°πâÕ¬·§à 10 μ—«°Á ‰¥â
°“√√–∫“¥¢Õ߇™◊ÈÕ EHEC O157:H7
∑’Ë¡’°“√μ‘¥μàÕ∑“ßÕ“À“√ ¡—°‡°‘¥®“°°“√√—∫
ª√–∑“πº≈‘μ¿—≥±å®“° μ— «å∑ª’Ë √ÿ߉¡à °ÿ À√◊Õ
‰¡àº“à π°“√æ“ ‡®Õ√å ‰√´å ‚¥¬‡©æ“–‡π◊ÕÈ ‚§∫¥
·μà “¡“√∂æ∫‰¥â„π‡π◊ÕÈ ·≈–‰ °â √Õ°™π‘¥Õ◊πË
·≈–π¡∑’Ë ‰¡àºà“π°“√æ“ ‡®Õ√å ‰√´å ·≈–™’
¡’°“√√–∫“¥Õ◊ËπÊ ∑’Ëæ∫«à“‡°’ˬ«¢âÕß°—∫À≠â“
Õ—≈ø“øÉ“ À√◊Õ·√¥‘™ °–À≈Ë”ª≈’ º—°‚¢¡
·≈–º—°™π‘¥Õ◊πË Ê ∑’¡Ë °’ “√ªπ‡ªóÕô 𠇙àπ‡¥’¬«
°—∫πÈ”º≈‰¡â∑’Ë ‰¡àºà“π°“√æ“ ‡®Õ√å ‰√´å πÈ”∑’Ë
π”¡“≈â“ߺ—°∑’Ë¡’°“√ªπ‡ªóôÕπÕÿ®®“√–°Á‡ªìπ
·À≈àߢÕ߇™◊ÈÕ EHEC O157:H7 „πº—°‰¥â
‚¥¬‡™◊È Õ ·∫§∑’ ‡ √’ ¬ “¡“√∂‡°“–Õ¬Ÿà ∫ πº‘ «
¢Õߺ—° ·≈– “¡“√∂¡’™«’ μ‘ Õ¬Ÿà ‰¥â¥∫’ πº‘«¢Õß
º≈‰¡â º—°·≈– ¡ÿπ‰æ√∑’Ëπ”¡“ª√ÿßÕ“À“√
À≈“¬™π‘¥ ‡™◊ÈÕ·∫§∑’‡√’¬®”π«π‰¡à¡“°∑’Ë
Õ¬Ÿà ∫ πº— ° ∑’Ë ≈â “ ß·≈â « Õ“®¡’ ° “√·∫à ß μ— « ‡æ‘Ë ¡
®”π«π¢÷ÈπÕ¬à“ß¡“°‰¥âÀ≈“¬«—π¢÷Èπ°—∫ ¿“«–
¢Õß ‘Ëß·«¥≈âÕ¡ ‡™◊ÈÕ EHEC O157:H7
“¡“√∂·∑√°‡¢â“‰ªÕ¬Ÿà¿“¬„π‡π◊ÈÕ‡¬◊ËÕ¢Õß
æ◊™∫“ß™π‘¥ √«¡∑—Èߺ—°°“¥ ´÷Ë߉¡à “¡“√∂
≈â“߇æ◊ÕË °”®—¥‡™◊ÕÈ ‰¥â ·¡≈ß«—πº≈‰¡â°Á “¡“√∂
·æ√à‡™◊ÈÕ Ÿà·Õª‡ªîô≈‰¥â ´÷Ë߇™◊ÈÕ “¡“√∂‡æ‘Ë¡
®”π«π‰¥â ∫ π‡π◊È Õ ‡¬◊Ë Õ º≈‰¡â ∑’Ë ¡’ √ Õ¬·μ°
84
‡™◊ÈÕ EHEC O157:H7 “¡“√∂¡’™’«‘μÕ¬Ÿà
„πº≈‘μ¿—≥±åÕ“À“√‰¥â¬“«π“π ‚¥¬Õ“®¡’
™’«‘쉥âÕ¬à“ßπâÕ¬ 9 ‡¥◊Õπ„π‡π◊ÈÕ‚§∫¥∑’Ë
‡°Á∫‰«â „πÕÿ≥À¿Ÿ¡‘ -20oC (-4oF) ‡™◊ÕÈ ¡’§«“¡
∑πμàÕ°√¥ ·≈–¬—ߧßμ‘¥‡™◊ÈÕÕ¬Ÿà „πÕ“À“√∑’Ë
¡’ ¿“«–‡ªìπ°√¥ ‡™àπ ¡“¬Õß‡π ‰ â°√Õ°
πÈ”·Õª‡ªîô≈À¡—° (apple cider) ·≈– ™’
‡™¥¥“ ´÷Ëß “¡“√∂§ßÕ¬Ÿà ‰¥â¬“«π“π‡ªìπ
—ª¥“Àå®π∂÷ßÀ≈“¬‡¥◊Õ𠇙◊ÈÕ¬—ß¡’§«“¡
§ß∑πμàÕ ¿“«–∑’Ë·Àâ߉¥â
∫“ß°√≥’ „π§π¡’°“√μ‘¥‡™◊ÈÕ‰¥â®“°°“√
—¡º— °—∫¥‘π·≈–πÈ”∑’Ë¡’°“√ªπ‡ªóôÕ𠇙◊ÈÕ
EHEC ¡—°∂Ÿ°°”®—¥‰¥â ‚¥¬°√–∫«π°“√∫”∫—¥
πÈ”¢Õ߇∑»∫“≈ ·μà‡™◊ÈÕ‡À≈à“π’ÈÕ“®‡°‘¥¢÷Èπ‰¥â
„π·À≈àßπÈ” à«π∫ÿ§§≈ ‡™àπ ∫àÕπÈ” °“√«à“¬πÈ”
„ππÈ” ∑’Ë ¡’ ° “√ªπ‡ªóô Õ π‡™◊È Õ ‚¥¬‡©æ“–„π
∑–‡≈ “∫·≈–≈”∏“√°Á¡’§«“¡‡°’ˬ«¢âÕß°—∫
°“√μ‘¥‡™◊ÈÕ„π∫“ß°√≥’ °“√ªπ‡ªóôÕπ¢Õß
‡™◊ÈÕ„π¥‘π°àÕ„À⇰‘¥°“√·æ√à√–∫“¥∑’Ë ∂“π
∑’Ëμ—Èß§à“¬·≈–∫√‘‡«≥Õ◊ËπÊ ´÷Ëß¡—°‡ªìπ∫√‘‡«≥
∑’Ë — μ «å ª »ÿ — μ «å ‰ ¥â ¡’ ° “√‡≈Á ¡ À≠â “ ¡“°à Õ π
√–¬–‡«≈“°“√Õ¬Ÿ√à Õ¥¢Õ߇™◊ÕÈ EHEC O157:H7
„𥑠π ∑’Ë ¡’ ° “√ªπ‡ªóô Õ π∑’Ë √ “¬ß“π‰«â æ ∫«à “
‡™◊È Õ ¡’ ™’ «‘ μ Õ¬Ÿà ‰¥âπ“π‡ªìπ‡¥◊Õπ∂÷ß¡“°°«à“
7 ‡¥◊Õ𠇙◊ÈÕ¬—ß “¡“√∂¡’™’«‘μÕ¬Ÿà „π·À≈àß
πÈ”®◊¥∫“ß·Àà߉¥âπ“π 2 ‡¥◊Õπ À√◊Õπ“π
°«à“π—Èπ‚¥¬‡©æ“–∑’ËÕÿ≥À¿Ÿ¡‘μË” ·≈–‡™◊ÈÕ
“¡“√∂¡’ ™’ «‘ μ Õ¬Ÿà ‰ ¥â „ππÈ”∑–‡≈‡ªìπ‡«≈“
2 —ª¥“Àå „π°“√»÷°…“Àπ÷Ëß· ¥ß„Àâ‡ÀÁπ
«à“‡™◊ÕÈ EHEC O157:H7 ∂Ÿ°¬—∫¬—ßÈ ‰¥â¿“¬„π
2 —ª¥“À凡◊Ë Õ Õ¬Ÿà „π‚§≈π „πÕ’°√“¬ß“π
Àπ÷Ëßæ∫«à“‡™◊ÈÕ “¡“√∂§ßÕ¬Ÿà ‰¥â¬“«π“π∂÷ß
3 ‡¥◊Õπ
¥â“π√–∫“¥«‘∑¬“¢Õ߇™◊ÈÕ EHEC ´’ ‚√‰∑ªá
Õ◊ËπÊ π—Èπ¬—߉¡à‡ªìπ∑’ˇ¢â“„®¡“°π—° —μ«åÕ“®
‡ªìπ‚Œ μå°—°‡°Á∫‡™◊ÈÕ EHEC O26 ¡“™‘°
¢Õ߇™◊ÕÈ „π´’ ‚√°√ÿªä π’∂È °Ÿ æ∫‰¥â „π μ— «åÀ≈“¬™π‘¥
ª√–°Õ∫¥â«¬‚§ ÿ°√ ·°– ·æ– °√–μà“¬
·≈–‰°à ‡™◊ÕÈ π’æÈ ∫‰¥â‡ªìπª°μ‘„π μ— «å∑’Ë ¢ÿ ¿“楒
‡™à 𠇥’ ¬ «°— ∫ — μ «å ∑’Ë · ¥ßÕ“°“√∑â Õ ß‡ ’ ¬
∂÷ß·¡â«à“®–¬—߉¡à∑√“∫·À≈àß∑’Ë¡“¢Õ߇™◊ÈÕ„π
À≈“¬Ê °√≥’ „π§π ·μà°“√√–∫“¥¢Õ߇™◊ÈÕ
EHEC O26 „π∫“ߧ√—ßÈ æ∫«à“ºà“π∑“ßÕ“À“√
(º≈‘μ¿—≥±å®“°‡π◊ÈÕ‚§·≈–π¡∑’Ë ‰¡àºà“π°“√
æ“ ‡®Õ√å ‰ √´å ) ‡°’Ë ¬ «¢â Õ ß°— ∫ °“√μ‘ ¥ μà Õ
—¡º— °—∫ —μ«å À√◊Õ‡°’ˬ«¢âÕß°—∫πÈ”∑’Ë¡’°“√
ªπ‡ªóôÕπÕÿ®®“√– ¡’√“¬ß“π∂÷ߧ«“¡‡ªìπ‰ª
‰¥â∑’Ë®–‡°‘¥°“√μ‘¥μàÕ√–À«à“ߧπ Ÿà§π ‡™◊ÈÕ
VTEC O103 “¡“√∂æ∫‰¥â „π‚§ ·°–
·≈–·æ– ·≈– “¡“√∂æ∫‰¥â∑—Èߧπ∑’Ë ÿ¢¿“楒
·≈–§π∑’˪ɫ¬ „π∑“ßμ√ß°—π¢â“¡‡™◊ÈÕ EHEC
O157:H- æ∫‰¥â πâ Õ ¬¡“°„π‚§·≈–¡â “
·≈–‰¡àæ∫‡™◊ÈÕ®“°μ—«Õ¬à“ß¡“°°«à“ 1,800
μ—«Õ¬à“ßÕÿ®®“√–¢Õß‚§ ·°– ·æ– ·≈–°«“ß
„π‡¬Õ√¡—π·≈–‡™Á° Õ¬à“߉√°Áμ“¡æ∫°“√
√–∫“¥§√—ÈßÀπ÷Ëߺà“π∑“ßÕ“À“√ (‰ â°√Õ°)
·≈–¡’§«“¡‡ªìπ‰ª‰¥â«à“°“√ —¡º— °—∫‚§·≈–
¡â“∑’μË ¥‘ ‡™◊ÕÈ ®–‡ªìπ·À≈àß∑’¡Ë “¢Õß°“√μ‘¥‡™◊ÕÈ
„π°“√√–∫“¥§√—ÈßÕ◊ËπÊ
°“√¶à“‡™◊ÈÕ
‡™◊ÈÕ E. coli “¡“√∂∂Ÿ°∑”≈“¬‰¥â®“°
°“√„™âπÈ”¬“¶à“‡™◊ÕÈ À≈“¬™π‘¥ ‰¥â·°à ‚´‡¥’¬¡
‰Œ‚ª§≈Õ‰√∑å 1% ‡Õ∑“πÕ≈ 70% ¬“¶à“
‡™◊ÈÕ®”æ«°øïπÕ≈À√◊Õ¬“¶à“‡™◊ÈÕ∑’Ë¡’ ‰Õ‚Õ¥’π
‡ªìπ à«πª√–°Õ∫æ◊Èπ∞“π ·≈–°≈Ÿμ“√—≈¥’ ‰Œ¥å
°—∫øÕ√å¡—≈¥’ ‰Œ¥å ‡™◊ÈÕπ’Ȭ—ß “¡“√∂∂Ÿ°¬—∫¬—Èß
‰¥â ‚¥¬„™â§«“¡√âÕπ™◊πÈ (121C [250F] ‡ªìπ
‡«≈“Õ¬à“ßπâÕ¬ 15 π“∑’) À√◊Õ„™â§«“¡√âÕπ
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
·Àâß (160-170C [320-338F] ‡ªìπ√–¬–
‡«≈“Õ¬à“ßπâÕ¬ 1 ™—Ë«‚¡ß) Õ“À“√§«√¡’°“√
ª√ÿß ÿ°∑’ËÕÿ≥À¿Ÿ¡‘Õ¬à“ßμË” 160F/ 71C
°“√„™â°—¡¡—πμ¿“æ√—ß ’À√◊Õ°“√„™â “√‡§¡’
æ«° “√≈–≈“¬‚´‡¥’ ¬ ¡‰Œ‚ª§≈Õ‰√∑å
Õ“®≈¥ À√◊Õ°”®—¥®”π«π‡™◊ÈÕ·∫§∑’‡√’¬∑’ËÕ¬Ÿà
„πº≈‘μ¿—≥±å ‰¥â
°“√μ‘¥‡™◊ÈÕ„π¡πÿ…¬å
√–¬–øí°μ—«
√–¬–øí°μ—«¢Õß‚√§∑’‡Ë °‘¥®“°‡™◊ÕÈ EHEC
O157:H7 Õ¬Ÿà„π™à«ß 1-16 «—π °“√μ‘¥‡™◊ÈÕ
à « π„À≠à ® –· ¥ßÕ“°“√À≈— ß ®“°μ‘ ¥ ‡™◊È Õ
3-4 «—π Õ¬à“߉√°Áμ“¡ §à“‡©≈’ˬ¢Õß√–¬–
‡«≈“øí°μ—«„π°“√√–∫“¥§√—ÈßÀπ÷Ëß∑’Ë ∂“π
∫”∫—¥·ÀàßÀπ÷Ëß §◊Õ 8 «—π
Õ“°“√
„π§π “¡“√∂μ‘ ¥ ‡™◊È Õ ·∫∫‰¡à · ¥ß
Õ“°“√ À√◊ÕÕ“®· ¥ßÕ“°“√‰¥âμ—Èß·μà∂à“¬
‡À≈«‡ªìππÈ” hemorrhagic colitis ·≈–°≈ÿ¡à
Õ“°“√ HUS ´÷ËßÕ“°“√ à«π„À≠àπ—Èπ‡√‘Ë¡μâπ
®“°°“√∑âÕ߇ ’¬ „πºŸâªÉ«¬∫“ß√“¬ “¡“√∂
À“¬‰¥â „π‡«≈“ª√–¡“≥ 1 ª— ¥“Àå‚¥¬‰¡àμÕâ ß
∑”°“√√—°…“ ºŸâªÉ«¬Õ◊ËπÊ ®–æ—≤π“Õ“°“√
hemorrhagic colitis ¿“¬„π√–¬–‡«≈“‰¡à°«’Ë π—
Õ“°“√®”‡æ“–¢Õß hemorrhagic colitis §◊Õ
¡’∑Õâ ߇ ¬’ Õ¬à“ß√ÿπ·√ß·≈–¡’‡≈◊Õ¥ªπ√à«¡°—∫
85
 Õ“°“√‡®Á∫∑’Ë∑âÕß ·≈–„πÀ≈“¬Ê √“¬∑’Ëæ∫
Õ“°“√ª«¥‡°√Áß∑âÕßÕ¬à“ß√ÿπ·√ß ºŸâªÉ«¬
∫“ß√“¬¡’ ‰¢âμË”Ê „πºŸâªÉ«¬Õ◊ËπÊ ®–‰¡àæ∫
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
Õ“°“√¡’ ‰ ¢â Õ“®æ∫Õ“°“√§≈◊Ë π ‰ â ·≈–
Õ“‡®’¬π‰¥â ·≈–¡’§«“¡‡ªìπ‰ª‰¥â∑æ’Ë ∫Õ“°“√
·ÀâßπÈ” ºŸªâ «É ¬À≈“¬√“¬∑’¡Ë Õ’ “°“√ hemorrhagic
colitis “¡“√∂À“¬‡Õß·≈–¥’¢÷Èπ‰¥â¿“¬„π
√–¬–‡«≈“ª√–¡“≥ 1 — ª ¥“Àå Õ“°“√
≈”‰ â „À≠à à«π‚§≈ÕπÕ—°‡ ∫·∫∫√ÿπ·√ß
Õ“®∑”„À⇰‘¥‡π◊ÈÕ쓬∑’Ë≈”‰ â °“√∑–≈ÿ À√◊Õ
‡°‘¥°“√μ’∫¢Õß≈”‰ â „À≠à à«π‚§≈Õπ
°≈ÿà¡Õ“°“√ HUS æ∫∂÷ß 16% ¢Õß
ºŸâªÉ«¬∑’Ë¡’Õ“°“√ hemorrhagic colitis °≈ÿà¡
Õ“°“√π’Èæ∫¡“°„π‡¥Á° ºŸâ ŸßÕ“¬ÿ ·≈–§π∑’Ë
¡’¿Ÿ¡‘§ÿâ¡°—πμË” ¡—°®–æ∫Õ“°“√π’ÈÀ≈—ß®“°
∑’Ë¡’Õ“°“√∑âÕ߇ ’¬¡“ 1 —ª¥“Àå „π∫“ߧ√—Èß
‡¥Á°Õ“®¡’Õ“°“√‡¡Á¥‡≈◊Õ¥·¥ß·μ° ·≈–
‰μ«“¬‚¥¬‰¡àæ∫Õ“°“√∑âÕ߇ ’¬‡ªìπÕ“°“√
‡√‘Ë¡μâπ °≈ÿà¡Õ“°“√ HUS ®–¡’≈—°…≥–
Õ“°“√®”‡æ“– §◊Õ‰μ«“¬ ‡≈◊Õ¥®“ß®“°
‡¡Á¥‡≈◊Õ¥·¥ß∂Ÿ°∑”≈“¬·≈–‡°≈Á¥‡≈◊Õ¥μË”
§«“¡ ”§—≠‡™‘ß —¡æ—∑∏å¢ÕßÕ“°“√‡À≈à“π’È
Õ“®·μ°μà“ß°—π‰ª ºŸâªÉ«¬∫“ß√“¬∑’Ë¡’Õ“°“√
HUS Õ“®æ∫Õ“°“√‡≈◊Õ¥®“ß®“°‡¡Á¥‡≈◊Õ¥
·¥ß∂Ÿ ° ∑”≈“¬ ·≈–/À√◊ Õ ‡°≈Á ¥ ‡≈◊ Õ ¥μË”
‚¥¬¡’Õ“°“√∑“ß‚√§‰μ‡æ’¬ß‡≈Á°πâÕ¬À√◊Õ‰¡à
æ∫‡≈¬ „π¢≥–∑’ºË ªŸâ «É ¬§πÕ◊πË Ê ¡’Õ“°“√∑“ß
‚√§‰μÕ¬à“ß™—¥‡®π·μà ‰¡àæ∫‡°≈Á¥‡≈◊Õ¥μË”
·≈–/À√◊Õ‡¡Á¥‡≈◊Õ¥·¥ß∂Ÿ°∑”≈“¬‡æ’¬ß‡≈Á°πâÕ¬
Õ“°“√Õ◊Ë π Ê πÕ°‡Àπ◊ Õ ®“°∑’Ë ‡ °’Ë ¬ «°— ∫ ‰μ
√«¡∂÷ßÕ“°“√∑“ß√–∫∫ª√– “∑¡—°æ∫Õ“°“√
ÕàÕπ·√ß ‰«√—∫μàÕ ‘Ëß°√–μÿâπ ·≈–™—°‰¥â∫àÕ¬
„π√“¬∑’Ë √ÿ π ·√ßÕ“®æ∫Õ“°“√Õ— ¡ 惰…å
86
‚√§À≈Õ¥‡≈◊Õ¥ ¡Õß·μ° (stroke) ¡Õß∫«¡
·≈–‚§¡à “ Õ“°“√·∑√°´â Õ π∑“ß√–∫∫
∑“߇¥‘πÀ“¬„® “¡“√∂∑”„À⇰‘¥πÈ”„π™àÕß
‡¬◊ÕË Àÿ¡â ªÕ¥ (pleural effusion) ¿“«–πÈ”‡°‘π
(fluid overload) ·≈–°≈ÿà¡Õ“°“√À“¬„®
≈”∫“°‡©’ ¬ ∫æ≈— π (adult respiratory
distress syndrome) Õ“®æ∫§à“‡Õπ‰´¡å
¢Õßμ—∫ÕàÕπ‡æ‘Ë¡ Ÿß¢÷Èπ À√◊Õμ—∫ÕàÕπÕ—°‡ ∫‰¥â
‡™àπ°—π ·μà¿“«–°≈â“¡‡π◊ÈÕ ≈“¬μ—«·≈–
§«“¡‡°’ˬ«¢âÕß°—∫°≈â“¡‡π◊ÈÕÀ—«„®π—Èπæ∫‰¥â
πâÕ¬¡“° √Ÿª·∫∫°≈ÿà¡Õ“°“√ HUS π—Èπ¡—°æ∫
‰¥â „πºŸâ „À≠à ‚¥¬‡©æ“–„πºŸâ ŸßÕ“¬ÿ „π∫“ߧ√—Èß
‡√’¬°Õ“°“√π’È«à“ thrombotic thrombocy-
topenic purpura (TTP) À√◊Õ¿“«–®È”‡≈◊Õ¥
®“°‡°≈Á¥‡≈◊Õ¥μË” ‚√§π’È®–æ∫Õ“°“√‰μ«“¬
‰¥â πâ Õ ¬„π‡¥Á ° ·μà “¡“√∂æ∫Õ“°“√∑“ß
√–∫∫ª√– “∑ª√–°Õ∫¥â«¬‚√§À≈Õ¥‡≈◊Õ¥
∑“ß ¡Õß ™—°·≈–√–∫∫ª√– “∑ à«π°≈“ß
‡ ◊ËÕ¡≈߉¥â∫àÕ¬¡“°°«à“ °“√‡ ’¬™’«‘μ‡°‘¥‰¥â
∫àÕ¬„πºŸâªÉ«¬∑’Ë¡’ ‚√§πÕ°‡Àπ◊Õ®“°‚√§‰μ∑’Ë
√ÿπ·√ß ‡™àπ Õ“°“√∑“ß√–∫∫ª√– “∑ à«π
°≈“ßÕ¬à“ß√ÿπ·√ß ‡¥Á°ª√–¡“≥ 65-85%
“¡“√∂øóôπμ—«®“°Õ“°“√ HUS ‰¥â ‚¥¬∑’Ë
‰¡à ¡’ § «“¡‡ ’ ¬ À“¬∂“«√ Õ¬à “ ߉√°Á μ “¡
¬— ß “¡“√∂æ∫Õ“°“√·∑√°´â Õ π¢Õ߉μ
„π√–¬–¬“«‰¥â ª√–°Õ∫¥â«¬§«“¡¥—π‡≈◊Õ¥ ߟ
¿“«–°“√∑”ß“π¢Õß‰μº‘¥ª°μ‘ ‰μ«“¬√–¬–
¥ÿ ∑⓬ ·≈–ªí≠À“∑’¬Ë ß— §ß¡’Õ¬Ÿπà Õ°‡Àπ◊Õ®“°
∑’Ë ‰μ ‡™àπ ‡∫“À«“π μ—∫ÕàÕπÀ≈—Ë߇Õπ‰´¡å
πâÕ¬≈ß Õ“°“√·∑√°´âÕπ∑“ß√–∫∫∑“߇¥‘π
Õ“À“√ À√◊Õ§«“¡º‘¥ª°μ‘∑“ß√–∫∫ª√– “∑
‡™à π Õ“®æ∫°“√§«∫§ÿ ¡ °“√∑”ß“π¢Õß
°≈â“¡‡π◊ÈÕ∑’Ë≈–‡Õ’¬¥ÕàÕπ‰¡àª°μ‘
§«“¡ “¡“√∂„π°“√μ‘¥μàÕ
°“√μ‘ ¥ μà Õ ®“°§π Ÿà § π‡°‘ ¥ ®“°°“√
°‘ π Õ“À“√∑’Ë ª π‡ªóô Õ πÕÿ ® ®“√–∑’Ë ¡’ ‡ ™◊È Õ
§π à«π„À≠à¡’°“√¢—∫‡™◊ÈÕ EHEC O157:H7
ÕÕ°¡“ª√–¡“≥ 7-9 «— π §π à « ππâ Õ ¬
“¡“√∂¢—∫‡™◊ÕÈ π’ÕÈ Õ°¡“‡ªìπ‡«≈“ 3 ª— ¥“Àå
À≈—ß®“°‡√‘Ë¡· ¥ßÕ“°“√ „π‰¡à°’Ë√“¬æ∫«à“
°“√¢—∫‡™◊ÕÈ Õ“®‡°‘¥μàÕ‡π◊ÕË ß‡ªìπ‡«≈“À≈“¬‡¥◊Õπ
„π‡¥Á°‡≈Á°¡’·π«‚πâ¡∑’Ë®–¢—∫‡™◊ÈÕ¬“«π“π
°«à“ºŸâ „À≠à °“√μ‘¥μàÕ√–À«à“߇¥Á°¡—°æ∫‰¥â
∫àÕ¬„π‡¥Á°∑’ˬ—ß„ àºâ“ÕâÕ¡
°“√«‘π‘®©—¬
‡π◊ËÕß®“°ª°μ‘§π®–‰¡àæ∫‡™◊ÈÕ EHEC
¥—ßπ—Èπ„π√“¬∑’Ë· ¥ßÕ“°“√ “¡“√∂«‘π‘®©—¬
‰¥â®“°°“√À“‡™◊ÕÈ „πμ—«Õ¬à“ßÕÿ®®“√– μ—«Õ¬à“ß
®“°Õ“À“√·≈– ‘Ë ß ·«¥≈â Õ ¡Õ“®π”¡“„™â
∑¥ Õ∫‰¥â‡™àπ°—π ‡æ◊ËÕæ‘®“√≥“·À≈àß∑’Ë¡“
¢Õ߇™◊ÈÕ ∫“ߧ√—Èß°“√μ√«®√–∫ÿ‡™◊ÈÕ EHEC
π—Èπ∑”‰¥â¬“° ‡™◊ÈÕ‡À≈à“π’ȇªìπ‡™◊ÈÕ°≈ÿà¡πâÕ¬
„πÕÿ®®“√– ·≈–„πÕ“À“√ ‡™◊ÈÕ‡À≈à“π’Ȭ—ß¡’
§«“¡§≈⓬§≈÷ß°—∫‡™◊ÈÕ E. coli ∑’ˇªìπ‡™◊ÈÕÕ‘ß
Õ“»—¬ ¬°‡«âπ„π‡√◊ÕË ß°“√ √â“ß verocytotoxin
Õ¬à“߉√°Áμ“¡ “√æ‘… verocytotoxin ‡æ’¬ß
Õ¬à “ ߇¥’ ¬ «‰¡à “¡“√∂„™â √ –∫ÿ «à “ ‡ªì 𠇙◊È Õ
EHEC ‰¥â ¬—ßμâÕßæ∫ªí®®—¬°“√°àÕ§«“¡√ÿπ·√ß
‡æ‘Ë¡‡μ‘¡¥â«¬ ÀâÕߪؑ∫—μ‘°“√„π°“√«‘π‘®©—¬
À≈“¬Ê ∑’Ë “¡“√∂À“‡™◊ÈÕ verocytotoxin-
producing E. coli (VTEC) ·≈–√–∫ÿ‡™◊ÈÕ
EHEC O157:H7 ‡™◊ÈÕ ‡μ√πÕ◊Ëπ∑’Ë ‰¡à „ ™à
EHEC O157 μâÕß∂Ÿ° à߉ªÀâÕߪؑ∫—μ‘°“√
Õâ“ßÕ‘ß ”À√—∫°“√μ√«®√–∫ÿ‡™◊ÈÕ ‰¡à ¡’ «‘ ∏’
«‘π®‘ ©—¬„¥‡æ’¬ß«‘∏‡’ ¥’¬«∑’®Ë – “¡“√∂·¬°‡™◊ÕÈ
EHEC ∑ÿ°´’ ‚√‰∑ªá ‰¥â
Õ“À“√‡≈’¬È ߇™◊ÕÈ ∑’®Ë ”‡æ“–μàÕ‡™◊ÕÈ (selective
media) ·≈–Õ“À“√‡≈’Ȭ߇™◊ÈÕ摇»…‡æ◊ËÕ°“√
§—¥·¬°™π‘¥¢Õ߇™◊ÈÕ (differential media)
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
∂Ÿ°æ—≤π“¢÷πÈ ¡“ ”À√—∫‡™◊ÕÈ EHEC O157:H7
‚¥¬Õ“»—¬À≈—°°“√∑’ˇ™◊ÈÕ‰¡à¡’ β-glucuroni-
dase ·≈– ‡μ√π¢Õ߇™◊ÈÕ à«π„À≠à‰¡à “¡“√∂
À¡—°πÈ”μ“≈´Õ√å∫∑‘ Õ≈‰¥âÕ¬à“ß√«¥‡√Á« π‘¬¡„™â
MacConkey agar ∑’¡Ë ´’ Õ√å∫∑‘ Õ≈ 1% (SMAC)
¡—°„ √à «à ¡°—∫¬“ªØ‘™«’ π–‡´øî°´’¡ (cefixime)
·≈–¡’πÈ”μ“≈·√¡‚π (rhamnose) À√◊Õ
‚æ·∑ ‡´’¬¡‡∑≈≈Ÿ‰√μå (potassium tellurite)
Õ¬à“ß„¥Õ¬à“ßÀπ÷ßË Õ“À“√‡≈’¬È ߇™◊ÕÈ hemorrhagic
colitis agar “¡“√∂„™â‡æ◊ÕË ·¬°‡™◊ÕÈ EHEC
O157:H7 ®“°Õ“À“√‰¥â Õ“À“√‡≈’¬È ߇™◊ÕÈ ™π‘¥
Õ◊ËπÊ ª√–°Õ∫¥â«¬ Õ“À“√‡≈’Ȭ߇™◊ÈÕ∑’Ë¡’ à«π
º ¡¢Õß “√∑’Ë∑”„À⇰‘¥ ’ (chromogenic
agars) ‡™àπ rainbow agar °Á “¡“√∂„™â ‰¥â
‡π◊ËÕß®“° ‡μ√πÕ◊ËπÊ ¢Õ߇™◊ÈÕ E. coli ·≈–
·∫§∑’‡√’¬™π‘¥Õ◊ËπÊ “¡“√∂‡®√‘≠‡μ‘∫‚쉥â
∫πÕ“À“√‡≈’Ȭ߇™◊ÈÕ‡À≈à“π’È °“√‡μ‘¡ “√‡æ◊ËÕ
°“√‡®√‘≠‡μ‘∫‚μ‡©æ“– ”À√—∫ E. coli O157
“¡“√∂™à«¬„π°“√μ√«®·¬°‡™◊ÈÕ‰¥â ‚¥¬‡©æ“–
„πμ—«Õ¬à“ß®“°Õ“À“√·≈–®“° ‘Ëß·«¥≈âÕ¡
‡æ◊Ëՙ૬„À⇙◊ÈÕ‡®√‘≠‰¥â¥’¢÷Èπ Õ“®π”μ—«Õ¬à“ß
¡“‡æ“–‡≈’¬È ß„πÕ“À“√‡≈’¬È ߇™◊ÕÈ ‡À≈«∑’‡Ë μ‘¡ “√
‡æ◊ËÕ‡ √‘¡°“√‡®√‘≠‡μ‘∫‚μ¢Õ߇™◊ÈÕ À√◊Õ„™â«‘∏’
Õ‘¡¡Ÿ‚π·¡Á°‡πμ‘° (immunomagnetic sepa-
ration; IMS) ‡æ◊ËÕ‡æ‘Ë¡§«“¡‡¢â¡¢âπ¢Õ߇™◊ÈÕ
·∫§∑’‡√’¬´’ ‚√°√ÿäª O157 °àÕπ∑’Ë®–π”¡“‡æ“–
≈ß„π®“π‡æ“–‡™◊ÈÕ «‘∏’Õ‘¡¡Ÿ‚π·¡Á°‡πμ‘°π—Èπ
®–„™â‡¡Á¥·¡à‡À≈Á°∑’ˇ§≈◊Õ∫¥â«¬·Õπμ‘∫Õ¥’
μàÕ·Õπ쑇®π O157 ‡æ◊ÕË ®—∫°—∫‡™◊ÕÈ ·∫§∑’‡√’¬
‡À≈à“π’È
87
 ‚§‚≈π’∑’Ë ß —¬«à“®–‡ªìπ‡™◊ÈÕ EHEC
O157:H7 “¡“√∂∂Ÿ°¬◊π¬—π«à“‡ªìπ‡™◊ÕÈ E.coli
‰¥â ® “°°“√∑¥ Õ∫∑“ß™’ « ‡§¡’ · ≈–æ∫
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
°“√· ¥ß¢Õß O157 ‡ªìπ·Õπ쑇®π∫π
ºπ—߇´≈≈å (somatic antigen) ·≈–æ∫ H7
‡ªìπ·Õπ쑇®π∫π·ø°‡®≈≈“ (flagellar
antigen) ‚¥¬«‘∏’∑“ßÕ‘¡¡Ÿ‚π·Õ ‡ ·≈–
«‘ ∏’ ∑ ¥ Õ∫Õ’ ° ¡“°¡“¬√«¡∂÷ ß ‡Õπ‰´¡å -
≈‘ߧåÕ‘¡¡Ÿ‚π´Õ√å‡∫π∑å·Õ ‡ (enzyme-
linked immunosorbent assays; ELISAs)
∑¥ Õ∫ªØ‘°‘√‘¬“°“√‡°“–°≈ÿà¡À√◊Õ·Õ°°≈Ÿμ‘-
‡π™—Ëπ (agglutination) «‘∏’ ‚æ≈’‡¡Õ‡√ -
‡™π√’·Õ§™—πË (PCR) ·≈–«‘∏Õ’ ¡‘ ¡Ÿ‚π∫≈Õμμ‘ßÈ
(immunoblotting) À√◊ Õ Vero cell
assay °Á “¡“√∂„™â ‰¥â‡æ◊ËÕμ√«®À“ “√æ‘…
verocytotoxin À√◊ Õ ¬’ π ∑’Ë √â “ ß “√æ‘ …
·≈–«‘ ∏’ ° “√®”·π°·∫§∑’ ‡ √’ ¬ (phage
typing) ·≈–«‘ ∏’ ° “√·¬°¥’ ‡ ÕÁ π ‡Õ‚¥¬„™â
°√–· ‰øøÑ“ 2 ∑‘»∑“ßÀ√◊Õæ—≈´åøî≈¥å‡®≈
Õ‘ ‡ ≈Á ° ‚∑√‚ø‡√´‘ (pulsed field gel
electrophoresis) “¡“√∂·¬°´—∫‰∑ªá¢Õß
‡™◊ÈÕ EHEC O157:H7 ‡æ◊ËÕ°“√»÷°…“∑“ß
√–∫“¥«‘∑¬“ «‘∏’‡À≈à“π’È „™â‡ªìπ«‘∏’∑—Ë«‰ª∑’Ë∑”
„πÀâÕߪؑ∫—μ‘°“√Õâ“ßÕ‘ß °“√·¬°´—∫‰∑ªá
(subtyping) ¡’§«“¡ ”§—≠„π°“√§âπÀ“
·À≈àß∑’Ë¡“¢Õß°“√√–∫“¥ ·≈–μ‘¥μ“¡°“√
μ‘¥μàÕ¢Õß‚√§‰¥â
«‘∏∑’ ’Ë„™â„π°“√√–∫ÿ‡™◊ÕÈ EHEC O157:H7
Õ“®∑”„Àâ æ ≈“¥°“√æ∫ ‡μ√πÕ◊Ë π Ê ∑’Ë
‰¡à§àÕ¬æ∫ √«¡∂÷߇™◊ÈÕ∑’Ë·¬°‰¥âπâÕ¬¡“°®“°
°“√À¡—°πÈ”μ“≈´Õ√å∫‘∑Õ≈ «‘∏’‡À≈à“π—Èπ¬—ß
‰¡à§àÕ¬¡’ª√– ‘∑∏‘¿“æ„π°“√μ√«®À“‡™◊ÈÕ
EHEC O157:H- ´÷Ëß “¡“√∂À¡—°πÈ”μ“≈
´Õ√å∫‘∑Õ≈ ·≈–¡’‡Õπ‰´¡å‡∫μ“°≈Ÿ§Ÿ‚√𑇥
88
(beta-glucuronidase) °“√√–∫ÿ‡™◊ÕÈ EHEC
O157:H- π—Èπ∑”‰¥â¬“°≈”∫“° ·μà “¡“√∂
∑”‰¥â ‚¥¬„™â«∏‘ «’ ∏‘ Õ’ ¡‘ ¡Ÿ‚π·¡Á°‡πμ‘° μ“¡¥â«¬
π”μ—«Õ¬à“߇擖≈ß∫π Sorbitol MacConkey
agar (SMAC) ·≈–∑¥ Õ∫°“√À¡—°πÈ”
μ“≈´Õ√å ∫‘ ∑ Õ≈·μà ≈ –‚§‚≈π’ ‡ æ◊Ë Õ μ√«®À“
·Õπ쑇®π O157 verocytotoxins À√◊Õ¬’π
„π°“√ √â“ß “√æ‘… ·≈–/À√◊Õªí®®—¬§«“¡
√ÿπ·√ßÕ◊ËπÊ
Õ“À“√‡≈’Ȭ߇™◊ÈÕ∑’Ë®”‡æ“–μàÕ‡™◊ÈÕ ·≈–
«‘∏’°“√·¬°‡™◊ÈÕ‰¥â¡’°“√æ—≤π“ ”À√—∫‡™◊ÈÕ
∫“ßμ—«„π°≈ÿ¡à ∑’Ë ‰¡à„™à‡™◊ÕÈ EHEC O157 ‡¡Á¥
·¡à ‡ À≈Á ° ¢Õß«‘ ∏’ Õ‘ ¡ ¡Ÿ ‚ π·¡Á ° ‡πμ‘ ° π—È π ¡’
®”Àπà“¬„π∑“ß°“√§â“‡æ◊ËÕ‡æ‘Ë¡§«“¡‡¢â¡¢âπ
¢Õ߇™◊ÈÕ EHEC ∫“ß´’ ‚√°√ÿäª ª√–°Õ∫¥â«¬
O26 O103 O111 ·≈– O145 Õ“À“√
‡≈’¬È ߇™◊ÕÈ rhamnose MacConkey ª√–°Õ∫
¥â « ¬¬“ªØ‘ ™’ « π–‡´øî ° ´’ ¡ ·≈–‡∑≈≈Ÿ ‰ √μå
(CT-RMAC) ∂Ÿ°π”¡“„™â „π°“√·¬°‡™◊ÈÕ
EHEC O26 °“√·¬°‡™◊ÈÕ à«π„À≠à¢Õß°≈ÿà¡
∑’Ë ‰¡à „™à‡™◊ÈÕ EHEC O157 Õ“»—¬°“√μ√«®
§— ¥ °√Õß‚§‚≈π’ ”À√— ∫ °“√μ√«® “√æ‘ …
verocytotoxin ¬’ π ∑’Ë √â “ ß “√æ‘ … ·≈–
ªí®®—¬§«“¡√ÿπ·√ßÕ◊ËπÊ ∑’ˇ°’ˬ«¢âÕß°—∫‡™◊ÈÕ
EHEC Õ“À“√‡≈’Ȭ߇™◊ÈÕ MacConkey À√◊Õ
™π‘¥Õ◊ËπÊ ∑’ˇ§¬„™â‡ªìπª°μ‘„π°“√‡æ“–‡≈’Ȭß
‡™◊ÈÕ E. coli “¡“√∂π”¡“„™â‡æ“–‡≈’Ȭ߇™◊ÈÕ
‡À≈à“π’È ‰¥â‡™àπ°—π «‘∏’°àÕπ°“√μ√«®§—¥°√Õß
∫“ß«‘∏’¡’‡ªÑ“À¡“¬μàÕ´’ ‚√°√ÿäª À√◊Õ´’ ‚√‰∑ªá
∑’Ë®”‡æ“–∑’ˇªìπ∑’Ë∑√“∫«à“‡°’ˬ«¢âÕß°—∫‚√§
∑’ˇ°‘¥®“°‡™◊ÈÕ EHEC „π§π «‘∏’∑’Ë „™â‡æ◊ËÕ
√–∫ÿ‡™◊ÈÕ à«π„À≠à∑’Ë ‰¡à „™à°≈ÿà¡ EHEC O157
‡ªìπ«‘∏∑’ ¡’Ë §’ «“¡¬ÿßà ¬“°¡“° ·≈–«‘∏°’ “√‡À≈à“π’È
‰¡à ‰¥â „™â „πÀâÕߪؑ∫—μ‘°“√ à«π„À≠à
 «‘∏’∑“ß¿Ÿ¡‘§ÿâ¡°—π«‘∑¬“·≈–«‘∏’∑’Ëμ√«®
À“°√¥π‘«§≈’Õ‘° (nucleic acid) ∑’Ë„™âμ√«®
À“·Õπ쑇®π O ·≈– H verocytotoxin À√◊Õ
¬’πÕ’°¡“°¡“¬∑’ˇ°’ˬ«¢âÕß°—∫‡™◊ÈÕ EHEC
“¡“√∂„™â‡æ◊ËÕ«‘π‘®©—¬‡∫◊ÈÕßμâπ «‘∏’°“√∑¥ Õ∫
∑’Ë „Àâº≈√«¥‡√Á«‡À≈à“π’È “¡“√∂„™âæ‘®“√≥“
»— ° ¬¿“æ¢Õ߇™◊È Õ °à Õ ‚√§∑’Ë æ ∫„πμ— « Õ¬à “ ß
°àÕπ∑’Ë®–π”¡“∑”°“√·¬°‡™◊ÈÕ «‘∏’‡À≈à“π’È
ª√–°Õ∫¥â«¬™ÿ¥πÈ”¬“μ√«®Õ¬à“ß√«¥‡√Á«
À√◊Õ¥‘ª μ‘Í° (dipstick) ·≈–‡∑§‚π‚≈¬’
‡¡¡‡∫√π (membrane technologies) «‘∏’
∑¥ Õ∫ªØ‘°√‘ ¬‘ “°“√‡°“–°≈ÿ¡à «‘∏’ ‰¡‚§√‡æ≈∑
(microplate assays) «‘∏’ ‚§‚≈π’Õ‘¡¡Ÿ‚π
∫≈Õμμ‘Èß (colony immunoblotting) PCR
Õ‘¡¡Ÿ‚πø≈ŸÕÕ‡√ ‡´π å (immunofluores-
cence) ·≈– ELISAs ∂÷ß·¡â«à“°“√ √â“ß
“√æ‘… verocytotoxin “¡“√∂™à«¬„π
°“√√–∫ÿμ—«‡™◊ÈÕ‰¥â ·μà ‰¡à®”‡ªìπ∑’ˇ™◊ÈÕ VTEC
®–‡ªìπ‡™◊ÈÕ EHEC ·≈–§«√μ√«®√–∫ÿÀ“
ªí®®—¬§«“¡√ÿπ·√ߢÕ߇™◊ÈÕ∑’ˇæ‘Ë¡¢÷Èπ¡“ °“√
∑’Ë ‰¡àæ∫Õπÿæ—π∏å¢Õß “√æ‘…„π‡™◊ÈÕ EHEC
Õ“®æ∫‰¥â∫“ߧ√—Èß„π™à«ß∑’Ë¡’æ—≤π“°“√¢Õß
°≈ÿ¡à Õ“°“√ HUS º≈¢Õß«‘∏«’ π‘ ®‘ ©—¬∑’√Ë «¥‡√Á«
“¡“√∂μ√«®¬◊π¬—π‰¥â®“°°“√‡æ“–·¬°‡™◊ÕÈ
„π§π∑’Ëμ‘¥‡™◊ÈÕ EHEC Õ“®‰¡àæ∫„πÕÿ®®“√–
À≈—ß®“°∑’Ë¡’°“√μ‘¥‡™◊ÈÕºà“π‰ª 1 —ª¥“Àå
«‘∏’∑“ß´’√—Ë¡«‘∑¬“¡’§«“¡ ”§—≠„π°“√
«‘π‘®©—¬„π§π ‚¥¬‡©æ“–™à«ßÀ≈—ß®“°‡ªìπ
‚√§´÷Ë ß ‡ªì π ™à « ß∑’Ë ¬ “°„π°“√μ√«®À“‡™◊È Õ
EHEC «‘∏’ indirect ELISAs “¡“√∂
μ√«®À“·Õπμ‘∫Õ¥’μÕà ‡™◊ÕÈ EHEC O157:H7
‡ªìπ‡«≈“À≈“¬‡¥◊ÕπÀ≈—ß®“°∑’Ë¡’°“√μ‘¥‡™◊ÈÕ
°“√‡°‘¥ªØ‘°‘√‘¬“¢â“¡°—∫‡™◊ÈÕ·∫§∑’‡√’¬Õ◊ËπÊ
“¡“√∂æ∫‰¥â
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
°“√√—°…“
°“√√—°…“Õ“°“√ hemorrhagic colitis
∑”‰¥â ‚¥¬°“√√—°…“·∫∫æ¬ÿßÕ“°“√ ·≈–
Õ“®√«¡∂÷ß°“√„Àâ “√πÈ” „ÀâÕ“À“√ÕàÕπÊ
à«π°“√„™â¬“ªØ‘™’«π–¬—߇ªìπ∑’Ë ‚μâ·¬âß°—π
Õ¬Ÿà·≈–¡—°®–À≈’°‡≈’ˬ߰“√„™â ‡π◊ËÕß®“°«à“
¬“ªØ‘ ™’ « π–‰¡à ™à « ¬≈¥°“√· ¥ßÕ“°“√
¢Õß‚√§ ‰¡àªÑÕß°—π°“√‡°‘¥¿“«–·∑√°´âÕπ
À√◊Õ≈¥°“√¢—∫‡™◊ÈÕ ·≈–Õ“®‡æ‘Ë¡§«“¡‡ ’ˬß
„π°“√‡°‘¥°≈ÿà¡Õ“°“√ HUS °“√„™â¬“≈¥
°“√‡§≈◊ËÕπ‰À«¢Õß∑“߇¥‘πÕ“À“√„π√“¬
∑’Ë¡Õ’ “°“√ hemorrhagic colitis π—Èπ°ÁÕ“®
∑”„Àâ‡æ‘Ë¡§«“¡‡ ’ˬßμàÕ°“√‡°‘¥°≈ÿà¡Õ“°“√
HUS ‰¥â ºŸâªÉ«¬∑’Ë¡’¿“«–·∑√°´âÕππ—Èπ§«√
‰¥â√—∫°“√√—°…“‡ªìπ摇»… ‡™àπ °“√øÕ°‰μ
°“√∂à“¬‡≈◊Õ¥ ·≈–/À√◊Õ°“√„À⇰≈Á¥‡≈◊Õ¥
ºŸâªÉ«¬∑’ˇ°‘¥Õ“°“√‰μ«“¬·∫∫∑’Ë ‰¡à “¡“√∂
°≈—∫¡“‡ªìπª°μ‘‰¥âÕ“®μâÕß∑”°“√ ºà“μ—¥
‡ª≈’¬Ë π‰μ
°“√ªÑÕß°—π
°“√≈â“ß¡◊Õ„Àâ∫àÕ¬§√—Èß‚¥¬‡©æ“–™à«ß
°àÕπ°‘πÕ“À“√À√◊Õ„π™à«ß∑’μË Õâ ߇μ√’¬¡Õ“À“√
·≈–°“√¡’ ÿ¢»“ μ√å∑’Ë¥’‡ªìπ ‘Ëß ”§—≠„π°“√
ªÑÕß°—π°“√μ‘¥μàÕ®“° —μ«å·≈– ‘Ëß·«¥≈âÕ¡
√Õ∫μ—« μ— «å §«√¡’∫√‘‡«≥≈â“ß¡◊Õ‡æ◊ÕË Õ”π«¬
§«“¡ –¥«°„π «π μ— «å·≈–„π∫√‘‡«≥Õ◊πË Ê
∑’Ë ™ÿ ¡ ™π¡’ ° “√μ‘ ¥ μà Õ — ¡ º— °— ∫ ª»ÿ — μ «å
·≈–§«√À≈’°‡≈’¬Ë ß°“√°‘πÕ“À“√ ·≈–°“√¥◊¡Ë
89
 πÈ” ∑’Ë ∫ √‘ ‡ «≥‡À≈à “ π’È ‡æ◊Ë Õ ‡ªì π °“√ªÑ Õ ß°— π
°“√μ‘ ¥ ‡™◊È Õ „π‡¥Á ° ·≈– ¡“™‘ ° „π∫â “ π
∫ÿ§§≈∑’Ë∑”ß“π∑’ˇ°’ˬ«¢âÕß°—∫ —μ«å§«√¡’°“√
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
‡°Á ∫ ‡ ◊È Õ ºâ “ ∑’Ë „™â∑”ß“π √«¡∂÷ß√Õ߇∑â“„Àâ
Àà“ß®“°∫√‘‡«≥∑’Ëæ—° ·≈–§«√¡’°“√·¬°
∑”§«“¡ –Õ“¥ „π‡¥Á° 2 §πæ∫°“√μ‘¥‡™◊ÈÕ
EHEC O157:H7 À≈—ß®“°∑’Ë¡’°“√ —¡º— °—∫
Õÿ®®“√–¢Õßπ° (μ√–°Ÿ≈°“) ´÷Ëß¡’‡ªìπ‰ª‰¥â
«à“ºà“π∑“ß√Õ߇∑â“∑”ß“π¢ÕßæàÕ ∑’˪π‡ªóôÕπ
¥‘πÀ√◊ÕÕ“®ªπ‡ªóÕô π¡“∫π‡ Õ◊È §≈ÿ¡ À≈—ß®“°
∑’Ë¡’°“√√–∫“¥¢Õß‚√§ ´÷Ë߇°’ˬ«¢âÕß°—∫°“√
‡¢â “ §à “ ¬„π À√“™Õ“≥“®— ° √À≈“¬§√—È ß
§≥–∑”ß“π‡©æ“–°‘®‡°’ˬ«°—∫‡™◊ÈÕ E. coli
O157 „π °äÕμ·≈π¥å (Scottish E.coli
O157 Task Force) ®÷ß¡’¢âÕ·π–π”‰¡à „Àâ
— μ «å ‡ §’È ¬ «‡Õ◊È Õ ß‡≈Á ¡ À≠â “ ∫√‘ ‡ «≥æ◊È π ∑’Ë π—È π
Õ¬à“ßπâÕ¬ 3 —ª¥“Àå°àÕπ‡√‘Ë¡¡’°“√‡¢â“§à“¬
«‘ ∏’ ° “√∑’Ë „ ™â ‡ æ◊Ë Õ ≈¥°“√ªπ‡ªóô Õ π¢Õ߇™◊È Õ
·∫§∑’‡√’¬√–À«à“ß°“√¶à“ ·≈–°“√μ—¥·μàß
´“° “¡“√∂™à « ¬≈¥§«“¡‡ ’Ë ¬ ߢÕ߇™◊È Õ
EHEC ®“°·À≈àß∑’¡Ë “π’È ‰¥â ¡’°“√®—¥‚ª√·°√¡
°“√§— ¥ °√Õß·≈–§«∫§ÿ ¡ °“√μ‘ ¥ ‡™◊È Õ ¢÷È π
”À√—∫‡™◊ÈÕ EHEC O157:H7 „π‡π◊ÈÕ —μ«å
‡æ◊ËÕªÑÕß°—π°“√ªπ‡ªóôÕπ¢â“¡√–À«à“ß°“√
‡μ√’¬¡Õ“À“√ ¥—ßπ—ÈπºŸâ∫√‘‚¿§§«√®–≈â“ß¡◊Õ
∑”§«“¡ –Õ“¥‚μä–Õ“À“√ ‡¢’¬ß ·≈–≈â“ß
Õÿª°√≥åμà“ßÊ ∑ÿ°§√—ÈßÀ≈—ß®“°∑’Ë¡’°“√ —¡º—
°—∫‡π◊ÈÕ¥‘∫ ‡π◊ÈÕ —μ«å§«√¡’°“√ª√ÿß„Àâ ÿ°‡æ◊ËÕ
¶à “ ‡™◊È Õ E. coli §«√À≈’ ° ‡≈’Ë ¬ ßπ¡À√◊ Õ
º≈‘μ¿—≥±åπ¡Õ◊ËπÊ ·≈–πÈ”º≈‰¡â∑’ˬ—߉¡àºà“π
°“√æ“ ‡®Õ√å ‰√´å
πÈ”∑’ËÕ“®¡’°“√ªπ‡ªóôÕπ°Á ‰¡à§«√¡’°“√
π”¡“„™â≈“â ßæ◊™º—° ·≈–¡Ÿ≈ μ— «å∑®’Ë –„™â‡ªìπªÿ¬Ü
90
·≈–πÈ” ∑‘È ß ∑’Ë ¬— ß ‰¡àºà“π°“√¶à“‡™◊ÈÕ°Á ‰ ¡à§«√
π”¡“„™âª≈Ÿ°º≈‰¡âÀ√◊Õº—°∑’Ë®–π”¡“°‘π¥‘∫
«‘∏’ªÑÕß°—πÀ≈—ß®“°°“√‡°Á∫‡°’ˬ«°Á§«√≈â“ß
º—°¥â«¬πÈ”‰À≈ºà“π‡æ◊ËÕ≈¥®”π«π·∫§∑’‡√’¬
º—°¬—ß “¡“√∂π”¡“¶à“‡™◊ÈÕ‰¥â¥â«¬ “√≈–≈“¬
§≈Õ√’π‡®◊Õ®“ß ∂â“„Àâª≈Õ¥¿—¬∑’Ë ÿ¥§«√≈â“ß
º— ° ∑— π ∑’ °à Õ π∑’Ë ® –π”º— ° ¡“°‘ π ‡π◊Ë Õ ß®“°
¿“¬„μâ ‘Ëß·«¥≈âÕ¡∫“ß ¿“«–∑”„Àâ®”π«π
·∫§∑’‡√’¬ “¡“√∂‡æ‘Ë¡®”π«πÕ’°§√—ÈßÀ≈—ß
®“°‡«≈“‰¡à°’Ë«—𠇙◊ÈÕ EHEC ∑’Ëæ∫‰¥â „π
‡π◊ÈÕ‡¬◊ËÕº—°π—Èπ∂Ÿ°∑”≈“¬‰¥â¬“°¬°‡«âπ°“√„™â
√—ß ’·≈–°“√ª√ÿß„Àâ ÿ°
“¡“√∂ªÑÕß°—π°“√ªπ‡ªóôÕπ¢Õß·À≈àß
®à“¬πÈ”„π™ÿ¡™π‰¥â ‚¥¬„™â√–∫∫°“√∫”∫—¥
πÈ”∑’Ë¡’¡“μ√∞“𠧫√À≈’°‡≈’ˬ߉¡à „Àâ —μ«å
ª»ÿ — μ «å Õ ¬Ÿà „ °≈â ™‘ ¥ °— ∫ ·À≈à ß πÈ” à « π∫ÿ § §≈
Õ“®∑”°“√∑¥ Õ∫‡™◊È Õ ∑“ß®ÿ ≈ ™’ « «‘ ∑ ¬“
ª√–™“™π§«√À≈’°‡≈’ˬ߰“√°≈◊ππÈ”¢≥–
«à“¬πÈ”∑’Ë √–πÈ” À√◊Õ‡≈àππÈ”„π∑–‡≈ “ª
∫àÕπÈ” ·≈–·¡àπÈ” “¬‡≈Á°Ê
ÿ¢»“ μ√å∑’Ë¥’ °“√≈â“ß∑”§«“¡ –Õ“¥
¡◊Õ ·≈–°“√®—¥°“√Õÿ®®“√–∑’Ë¡’‡™◊ÈÕ∑’ˇÀ¡“– ¡
“¡“√∂™à«¬≈¥°“√μ‘¥μàÕ√–À«à“ß§π §Ÿà π‰¥â
°“√≈â“ß¡◊Õ¡’§«“¡ ”§—≠‡ªìπ摇»…À≈—ß®“°
∑’Ë¡’°“√‡ª≈’ˬπºâ“ÕâÕ¡ À≈—ß®“°°“√„™âÀâÕßπÈ”
·≈–°àÕπ°‘πÕ“À“√À√◊Õ‡μ√’¬¡Õ“À“√ ºâ“ªŸ
∑’ËπÕπ ºâ“‡™Á¥μ—«·≈–‡ ◊ÈÕºâ“∑’˪π‡ªóôÕπ¥‘π
¢ÕߺŸâªÉ«¬∑’Ë¡’Õ“°“√ hemorrhagic colitis
§«√¡’°“√·¬°∑”§«“¡ –Õ“¥ ·≈–∑’Ëπ—Ëß
™—°‚§√° ·≈–μ”·Àπàß∑’°Ë ¥™—°‚§√°§«√¡’°“√
∑”§«“¡ –Õ“¥Õ¬à“߇À¡“– ¡ „π∫“ßæ◊Èπ∑’Ë
°Æ¢âÕ∫—ߧ—∫Õ“®Àâ“¡‡¥Á°∑’¡Ë °’ “√μ‘¥‡™◊ÕÈ ‰¡à„Àâ
Õ¬Ÿà ∑’Ë ∂“π√— ∫ ‡≈’È ¬ ߇¥Á ° À√◊ Õ ‚√߇√’ ¬ π®π
°√–∑—ßË ‡¥Á°‡À≈à“π—πÈ ‰¡à¡°’ “√ª≈àÕ¬‡™◊ÕÈ ÕÕ°¡“
‡ªìπ√–¬–‡«≈“π“π ¡’°“√‡ πÕ·π–«à“°“√
·¬°‡¥Á°∑’μË ¥‘ ‡™◊ÕÈ ÕÕ°®“°æ’πË Õâ ß À√◊Õ ¡“™‘°
‡¥Á°§πÕ◊πË „π∫â“π “¡“√∂™à«¬≈¥§«“¡‡ ¬’Ë ß
„π°“√·æ√à√–∫“¥¢Õß‚√§μàÕ‰¥â
§«“¡‡ ’ˬߢÕߧπ®–≈¥≈߉¥â∂Ⓡ™◊ÈÕ
EHEC „π —μ«å¡’ª√‘¡“≥≈¥≈ßÀ√◊Õ∂Ÿ°°”®—¥
‰¥âÀ¡¥‰ª‰¥â
Õ—μ√“°“√ªÉ«¬·≈–Õ—μ√“°“√쓬
°“√μ‘¥‡™◊ÈÕ EHEC “¡“√∂‡°‘¥‰¥â
‡ªì π §√—È ß §√“«À√◊ Õ ‡°‘ ¥ ‡ªì π °“√√–∫“¥
„π∑«’ªÕ‡¡√‘°“‡Àπ◊Õæ∫«à“°“√μ‘¥‡™◊ÕÈ EHEC
O157:H7 π—Èπæ∫‰¥â∫àÕ¬μ—Èß·μà™à«ßƒ¥Ÿ√âÕπ
®π∂÷߃¥Ÿ„∫‰¡â√à«ß „π À√“™Õ“≥“®—°√æ∫
·π«‚πâ¡°“√μ‘¥‡™◊ÈÕμ—Èß·μà „π™à«ßª≈“¬ƒ¥Ÿ
„∫‰¡âº≈‘®π∂÷ß™à«ßª≈“¬ƒ¥Ÿ√Õâ π °“√‡°‘¥‚√§
μ“¡ƒ¥Ÿ°“≈π—ÈπÕ“®¡’ “‡Àμÿ¡“®“°√Ÿª·∫∫
°“√¢— ∫ ‡™◊È Õ ·∫§∑’ ‡ √’ ¬ ¢Õß — μ «å À√◊ Õ Õ“®
‡π◊ÕË ß®“°ªí®®—¬Õ◊πË Ê ‡™àπ °“√°‘π‡π◊ÕÈ ∑’ˉ¡àº“à π
°“√ª√ÿ ß ÿ ° „π™à « ß∫“√å ∫’ §‘ « „πƒ¥Ÿ √â Õ π
„π∑“ßμ√ß°— π ¢â “ ¡°“√μ‘ ¥ ‡™◊È Õ EHEC
O157:H- ¡—°æ∫‰¥â∫Õà ¬„π‡¥Á°∑’¡Ë Õ’ “¬ÿμË”°«à“
3 ªï ´÷ßË ¡’·π«‚πâ¡æ∫‰¥â¡“°„π™à«ßƒ¥ŸÀπ“«
Õÿ∫—μ‘°“√≥å°“√μ‘¥‡™◊ÈÕ EHEC „π§π
π—È𬓰∑’Ë®– “¡“√∂§“¥°“√≥å ‰¥â‡π◊ËÕß®“°
„π√“¬∑’¡Ë Õ’ “°“√∑âÕ߇ ¬’ ·∫∫‰¡à√πÿ ·√ßÕ“®
‰¡à ‰¥â¡’°“√∑¥ Õ∫«à“¡’°“√μ‘¥‡™◊ÈÕ‡À≈à“π’È
„πªï æ.». 2547 ¡’√“¬ß“π°“√ª√–¡“≥
Õÿ∫—μ‘°“√≥åª√–®”ªï¢Õß°“√μ‘¥‡™◊ÈÕ EHEC
O157:H7 „π °ÁÕμ·≈π¥å À√—∞Õ‡¡√‘°“
‡¬Õ√¡—π ÕÕ ‡μ√‡≈’¬ ≠’˪ÿÉπ ·≈–‡°“À≈’Õ¬Ÿà
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
„π™à«ß 0.08 ∂÷ß 4.1 √“¬μàÕª√–™“°√
100,000 √“¬ ‚¥¬ °ÁÕμ·≈π¥å¡’Õÿ∫—μ‘°“√≥å
ߟ ∑’Ë ¥ÿ „π À√—∞Õ‡¡√‘°“ Center for Disease
Control and Prevention (CDC) 䴉
ª√–¡“≥°“√«à “ ‡™◊È Õ EHEC O157:H7
°à Õ „Àâ ‡ °‘ ¥ °“√ªÉ « ¬ 73,000 √“¬ 2,000
μâ Õ ß‡¢â “ ‚√ß欓∫“≈ ·≈–¡’ § π‡ ’ ¬ ™’ «‘ μ
ª√–¡“≥ 50-60 §πμàÕªï §«“¡™ÿ°¢Õß°“√
μ‘¥‡™◊ÈÕ°≈ÿà¡∑’Ë ‰¡à „™à EHEC O157 „π§π ¡’
§«“¡‡ªìπ‰ª‰¥â«“à ®–μË”°«à“∑’ªË √–¡“≥‡Õ“‰«â
‡π◊ËÕß®“°ÀâÕߪؑ∫—μ‘°“√ à«π„À≠àπ—Èπ‰¡à ‰¥â
∑”°“√μ√«®§— ¥ °√Õ߇™◊È Õ π’È ‡ ªì π ª°μ‘ „π
À√—∞Õ‡¡√‘°“Àπ૬ߓπ CDC ‰¥âª√–¡“≥
°“√Õÿ∫—μ‘°“√≥å¢Õß°“√μ‘¥‡™◊ÈÕ°≈ÿà¡ ∑’Ë ‰¡à „™à
‡™◊ÕÈ EHEC O157 «à“¡’§«“¡§≈⓬§≈÷ß°—∫‡™◊ÕÈ
EHEC O157 „π∑«’ª¬ÿ‚√ª ≈–μ‘π Õ‡¡√‘°“
·≈–ÕÕ ‡μ√‡≈’ ¬ ∫“ßÀ≈— ° ∞“π· ¥ß«à “
¡’°“√μ‘¥‡™◊ÈÕ°≈ÿà¡Õ◊Ëπ∑’Ë ‰¡à „™à EHEC O157
Õ“®æ∫‰¥â ∫à Õ ¬„π§π¡“°°«à “ °“√μ‘ ¥ ‡™◊È Õ
EHEC O157:H7
„π√“¬∑’Ë· ¥ßÕ“°“√æ∫Õ—μ√“°“√쓬
¡’§«“¡·ª√º—π‰ªμ“¡°≈ÿà¡Õ“°“√ Õ“°“√
hemorrhagic colitis ‡æ’¬ßÕ¬à“߇¥’¬«π—Èπ
¡—°À“¬‰¥â‡Õß ·μà„π∫“ß√“¬°ÁÕ“®‡ ¬’ ™’«μ‘ ‰¥â
®”π«πºŸâªÉ«¬∑’Ë®–æ—≤π“Õ“°“√‰ª‡ªìπ°≈ÿà¡
Õ“°“√ HUS ®–·ª√º—π‰ªμ“¡™π‘¥¢Õ߇™◊ÕÈ
·≈–°“√√–∫“¥ª√–¡“≥ 5-10% ¢ÕߺŸâªÉ«¬
∑’Ë¡’Õ“°“√ hemorrhagic colitis ®“°°“√
μ‘¥‡™◊ÈÕ EHEC O157:H7 ¡—°¡’æ—≤π“°“√
¢Õß‚√§‡ªìπ°≈ÿ¡à Õ“°“√ HUS Õ¬à“߉√°Áμ“¡
91
 ‰¥â¡’√“¬ß“πÕÿ∫—μ‘°“√≥å°“√‡°‘¥‚√§∑’Ë 16%
‚¥¬‡©æ“–„π™à«ß∑’Ë¡’°“√√–∫“¥Õ¬à“ß√ÿπ·√ß
∑’¡Ë §’ «“¡‡°’¬Ë «¢âÕß°—∫º—°‚¢¡ „π À√—∞Õ‡¡√‘°“
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
Õ“°“√·∑√°´â Õ π·≈–Õ— π μ√“¬∂÷ ß ¢—È π
‡ ’ ¬ ™’ «‘ μ “¡“√∂æ∫‰¥â ∫à Õ ¬‚¥¬‡©æ“–
„π‡¥Á° ºŸâ ŸßÕ“¬ÿ ·≈–∫ÿ§§≈∑’Ë¡’¿Ÿ¡‘§ÿâ¡°—π
∂Ÿ ° °¥ À√◊ Õ ∫ÿ § §≈∑’Ë ªÉ « ¬√à “ ß°“¬Õà Õ π·Õ
„π‡¥Á°∑’¡Ë °’ ≈ÿ¡à Õ“°“√ HUS π—πÈ æ∫Õ—μ√“°“√
‡ ’¬™’«‘μ∑’Ë 3-10% ·≈–„πºŸâ ŸßÕ“¬ÿ æ∫«à“
¿“«–®È”‡≈◊Õ¥®“°‡°≈Á¥‡≈◊Õ¥μË”¡’Õ—μ√“°“√
‡ ’¬™’«‘μ Ÿß∂÷ß 50%
°“√μ‘¥‡™◊ÈÕ„π —μ«å
™π‘¥ —μ«å∑’Ë ‰¥â√—∫º≈°√–∑∫
—μ«å‡§’Ȭ«‡Õ◊ÈÕß‚¥¬‡©æ“–‚§ ·≈–·°–
‡ªìπ‚Œ μå°—°‡°Á∫‚√§À≈—°¢Õ߇™◊ÈÕ EHEC
0157:H7 °√–∑‘߉∫´—π ·≈–°«“ß°Á “¡“√∂
μ‘¥‡™◊ÕÈ ‰¥â ∫“ߧ√—ßÈ ‡™◊ÕÈ π’È “¡“√∂æ∫‰¥â„π μ— «å
‡≈’Ȭß≈Ÿ°¥â«¬π¡Õ◊ËπÊ ‡™àπ ÿ°√ °√–μà“¬
¡â“ ÿπ—¢ ·√§§Ÿπ ·≈–‚ÕæÕ ´—¡ ·≈–
„π —μ«åªï°‰¥â·°à ‰°à ‰°àß«ß Àà“π π°æ‘√“∫
π°π“ßπ«≈ π°μ√–°Ÿ ≈ °“ ·≈–π°ªÉ “
Õ’°À≈“¬™π‘¥ „π∫“ß°√≥’‰¡à∑√“∫·πà™—¥«à“
—μ«å ªï™’ åπ—Èπ‡ªìπ‚Œ μå°—°‡°Á∫‚√§ À√◊Õ
‡ªì π ‡æ’ ¬ ßæ“À–™—Ë « §√“« μ— « Õ¬à “ ߇™à π
°√–μà“¬ “¡“√∂¢—∫‡™◊ÈÕ EHEC O157:H7
´÷Ëß°àÕ„À⇰‘¥°“√√–∫“¥„π§π ·μà°√–μà“¬
∑’Ëμ‘¥‡™◊ÈÕ à«π„À≠àπ—Èπæ∫«à“Õ“»—¬Õ¬Ÿà „°≈â°—∫
ø“√å¡∑’Ë¡’ ‚§∑’ˇªìπ‚√§
¬—߉¡à‡ªìπ∑’ˇ¢â“„®·πà™—¥∂÷ß‚Œ μå°—°‡°Á∫
‚√§¢Õ߇™◊ÈÕ°≈ÿà¡∑’Ë ‰¡à „™à EHEC O157 ¡’
°“√æ∫ ¡“™‘°¢Õ߇™◊ÈÕ„π´’ ‚√°√ÿäª O26 ‰¥â
92
„π‚§ ÿ°√ ·°– ·æ– °√–μà“¬ ·≈–‰°à
Õ¬à“߉√°Áμ“¡ ‡™◊ÈÕ‡À≈à“π’È∑—ÈßÀ¡¥‰¡à®”‡ªìπ
«à“®–μâÕ߇ªìπ‡™◊ÈÕ EHEC ‡™◊ÈÕ VTEC O103
π—Èπ “¡“√∂æ∫‰¥â „π‚§ ·°– ·≈–·æ–‡™àπ
‡¥’¬«°—∫„π§π∑’¡Ë ’ ¢ÿ ¿“æ·¢Áß·√ß·≈–§πªÉ«¬
‡™◊ÈÕ EHEC O145 “¡“√∂æ∫‰¥â „π‚§ ·μà
æ∫‰¥âπâÕ¬°«à“‡™◊ÈÕ EHEC O26 Õ’°Àπ÷Ëß
´’ ‚√‰∑ªá §◊Õ ‡™◊ÈÕ EHEC O145:H- ∑’Ë·¬°
‡™◊ÈÕ‰¥â „π·¡«μ—«Àπ÷Ëß∑’ˇ°’ˬ«¢âÕß°—∫ºŸâªÉ«¬
√“¬Àπ÷Ëß ´÷Ë߬—߉¡à ‡ ªì π ∑’Ë ∑ √“∫·πà π Õπ«à “
‡¥Á ° ∑’Ë ªÉ « ¬μ‘ ¥ ‡™◊È Õ ¡“®“°·¡« À√◊ Õ ·¡«
μ‘¥‡™◊ÈÕ¡“®“°‡¥Á° ‡™◊ÈÕ O157:H- ∂Ÿ°æ∫‰¥â
„π·¡à ‚§ ·≈–¡â “ ·μà ® “°°“√ ”√«®„π
‡¬Õ√¡—π·≈–‡™Á°æ∫«à“´’ ‚√‰∑ªáπ’È “¡“√∂
æ∫‰¥âπâÕ¬¡“°À√◊Õ‰¡àæ∫„π‚§ ·°– ·æ–
·≈–°«“ß „π°√–μà“¬‡≈’Ȭßæ∫«à“‡ªìπ‚Œ μå
°—°‡°Á∫‚√§¢Õ߇™◊ÈÕ EHEC O153:H- ·≈–
O153:H7
Õ“°“√
‡™◊ÈÕ EHEC O157:H7 π—Èπ‰¡à‡°’ˬ«¢âÕß
°—∫°“√μ‘¥‡™◊ÈÕμ“¡∏√√¡™“μ‘„π —μ«å „π°“√
∑¥≈Õß∑”„Àâ쥑 ‡™◊ÕÈ „π≈Ÿ°‚§æ∫«à“´’ ‚√‰∑ªáπ’È
¥Ÿ‡À¡◊Õπ«à“®–‰¡à ‰¥â‡ªì𠓇Àμÿ¢Õß‚√§„π
—μ«å∑’ËÕ“¬ÿ¡“°°«à“ 1 —ª¥“Àå √“¬ß“πÀπ÷Ëß
∑’Ë∑¥≈Õß„Àâ¡’°“√μ‘¥‡™◊ÈÕ„π≈Ÿ°‚§∑’ˇæ‘Ëߧ≈Õ¥
(Õ“¬ÿπâÕ¬°«à“ 2 «—π) æ∫Õ“°“√∑âÕ߇ ’¬∑’Ë¡’
‡≈◊Õ¥ À√◊Õ‡¡◊Õ°ªπ ·≈–æ∫°“√쓬‰¥â∫â“ß
Õ’°°“√ »÷°…“Àπ÷Ëß√“¬ß“π∂÷ß°“√ªÉ«¬„π≈Ÿ°
°ÿ √∑¥≈Õß∑’ªË √“»®“°‡™◊ÕÈ ∫“ß™π‘¥ (gnoto-
biotic) ÿπ—¢∑’Ëπ”¡“∑¥≈Õß‚¥¬°“√©’¥‡™◊ÈÕ
EHEC O157:H7 æ∫«à“‡°‘¥¿“«–∑âÕ߇ ’¬
‡©’¬∫æ≈—π™—Ë«§√“«√à«¡°—∫Õ“°“√‡∫◊ËÕÕ“À“√
·≈–Õ“‡®’¬π ·μàæ∫«à“ —μ«å “¡“√∂À“¬‰¥â
‡Õß„π 1-2 «—π‚¥¬‰¡à ¡’ ¿ “«–·∑√°´â Õ π
„π°“√∑¥≈Õß∑”πÕ߇¥’ ¬ «°— π ‚¥¬©’ ¥ ‡™◊È Õ
°≈ÿà¡∑’Ë ‰¡à „™à EHEC O157 „π ÿπ—¢æ∫«à“¡’
°“√æ—≤π“¢Õß‚√§∑’√Ë πÿ ·√ß ¡’Õ“°“√∑âÕ߇ ¬’
·≈–Õ“‡®’ ¬ πμ“¡¥â « ¬¿“«–Õà Õ π·√ß·≈–
‡∫◊ËÕÕ“À“√ ¿“«–·ÀâßπÈ”·≈–πÈ”Àπ—°≈¥≈ß
ÿπ—¢‡À≈à“π’Ȭ—ß¡’Õ“°“√∑“ß√–∫∫ª√– “∑
ª√–°Õ∫¥â«¬Õ“°“√™—° ¡Õß à«π´’√’∫√—¡
‡°‘¥‡ªìπ‡π◊ÈÕ쓬 (cerebral infarction)
μ“∫Õ¥ ‚§¡à“ ‡ ’¬™’«‘μ¿“¬„π 5-6 «—πÀ≈—ß
®“°∑’‡Ë √‘¡Ë ¡’°“√· ¥ßÕ“°“√¢Õß‚√§ ‡™◊ÕÈ ∑’ÕË ¬Ÿà
„π∫“ß´’ ‚√°√ÿäª∑’Ë ‰¡à „™à°≈ÿà¡ EHEC O157
ª√–°Õ∫¥â«¬ O26 O111 O118 ·≈– O103
∑”„Àâ ‡ °‘ ¥ Õ“°“√∑â Õ ß‡ ’ ¬ ·≈–Õ“°“√∑“ß
√–∫∫∑“߇¥‘πÕ“À“√„π≈Ÿ° —μ«å ‡™◊ÈÕ EHEC
O118:H16 ¡—°¡’§«“¡‡°’ˬ«¢âÕß °—∫Õ“°“√
∑âÕ߇ ’¬„π≈Ÿ°‚§ ·≈– “¡“√∂¬◊π¬—πº≈‰¥â
®“°°“√∑¥≈Õß©’ ¥ ‡™◊È Õ „π≈Ÿ ° ‚§‡°‘ ¥ „À¡à
Õ¬à“߉√°Áμ“¡ °“√»÷°…“∑“ß√–∫“¥«‘∑¬“
¢Õ߇™◊ÈÕ EHEC à«π„À≠à‡ªìπ°“√ª√–¡“≥
°“√¡“°°«à“°“√¬◊π¬—πÕ¬à“ß™—¥‡®π ¡’°“√
»÷°…“πâÕ¬∑’Ë„™â‡™◊ÈÕ E. coli ‡μ√π∑’Ë∑√“∫
·πà™—¥ ·≈–°“√∑¥≈Õß à«π„À≠à∂Ÿ°∑”°àÕπ
∑’Ë®–¡’§«“¡‡¢â“„®‡°’ˬ«°—∫≈—°…≥–¢Õߧ«“¡
√ÿπ·√ß®”‡æ“–¢Õ߇™◊ÈÕ EHEC ‡™◊ÈÕ ‡μ√π
VTEC ∑’Ë¡’§«“¡‡°’ˬ«¢âÕß°—∫Õ“°“√∑âÕ߇ ’¬
„π°“√∑¥≈Õß∑’∑Ë ”„Àâ쥑 ‡™◊ÕÈ „π≈Ÿ°‚§ ª√–°Õ∫
¥â«¬ VTEC O5:H- VTEC O8:H9, VTEC
O26:H11 VTEC O26:H- VTEC O26
VTEC O80:H- ·≈– VTEC O111:H-
„πÀ≈“¬Ê °√≥’ ·μà‰¡à∑°ÿ °√≥’®–æ∫∑âÕ߇ ¬’
·∫∫¡’‡≈◊Õ¥ ·≈–‡¡◊Õ°ªπ
‡™◊ÈÕ EHEC O153:H- ¡’§«“¡‡°’ˬ«¢âÕß°—∫
°“√√–∫“¥¢ÕßÕ“°“√∑âÕ߇ ¬’ ·∫∫¡’‡≈◊Õ¥ªπ
·≈–Õ“°“√ªÉ«¬∑’˧≈⓬§≈÷ß°—∫°≈ÿà¡Õ“°“√
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
HUS „π°√–μà“¬‡≈’È¬ß °√–μà“¬∑’Ë∂Ÿ°∑”„Àâ
μ‘¥‡™◊ÈÕ®“°°“√∑¥≈Õß¡’°“√æ—≤π“Õ“°“√
∑â Õ ß‡ ’ ¬ ‡ªì π ‡≈◊ Õ ¥√à « ¡°— ∫ Õ“°“√Õà Õ π·√ß
‡∫◊ËÕÕ“À“√ ·ÀâßπÈ” ·≈–πÈ”Àπ—°≈¥
§«“¡ “¡“√∂„π°“√μ‘¥μàÕ
— μ «å ∑’Ë μ‘ ¥ ‡™◊È Õ ·∫∫‰¡à· ¥ßÕ“°“√π—Èπ
“¡“√∂¢—∫‡™◊ÈÕ EHEC °“√¢—∫‡™◊ÈÕÕ“®‡ªìπ
·∫∫™—Ë«§√“«À√◊Õ‰¡àμàÕ‡π◊ËÕß ·≈– —μ«å∑’Ë
À¬ÿ¥°“√¢—∫‡™◊ÈÕπ’ÈÕ“®°≈—∫¡“¡’‡™◊ÈÕ‡æ‘Ë¡‰¥â
Õ’°§√—ßÈ ¡’§«“¡‡ªìπ‰ª‰¥â¡“°«à“≈Ÿ°‚§ “¡“√∂
¢—∫‡™◊ÈÕ EHEC O157:H7 ‰¥â¡“°°«à“‚§∑’Ë
‚μ‡μÁ¡∑’Ë °ÿ √∑’μË ¥‘ ‡™◊ÕÈ ®“°°“√∑¥≈Õß “¡“√∂
¢—∫‡™◊ÈÕπ’È ‰¥â‡ªìπ‡«≈“Õ¬à“ßπâÕ¬ 2 ‡¥◊Õπ
√Õ¬‚√§À≈—ß°“√쓬
√Õ¬‚√§®“°°“√μ‘ ¥ ‡™◊È Õ EHEC „π
— μ «å ‡ §’È ¬ «‡Õ◊È Õ ßπ—È π ¡— ° æ∫°“√Õ— ° ‡ ∫¢Õß
‡¬◊Ë Õ ∫ÿ ≈”‰ â ·≈–¡— ° ®–®”°— ¥ ‡©æ“–∑’Ë
≈”‰ â „À≠à „π∫“ß°√≥’æ∫¢Õ߇À≈«®“°°“√
Õ— ° ‡ ∫∑’Ë ¡’ ≈— ° …≥–¢Õ߉ø∫√‘ π ·≈–‡≈◊ Õ ¥
(fibrinohemorrhagic exudates)
°√–μà “ ¬∑’Ë ∂Ÿ ° ∑¥≈Õß∑”„Àâ μ‘ ¥ ‡™◊È Õ
EHEC O153 æ∫«à“≈”‰ â „ À≠à à « π´’ °— ¡
(cecum) ·≈–/À√◊Õ≈”‰ â „À≠à à«π‚§≈Õπ
à«πμâπ (proximal colon) ¡’°“√∫«¡πÈ”
Àπ“μ—« ·≈–æ∫®ÿ¥‡≈◊Õ¥ÕÕ° (petechial)
À√◊Õ (ecchymotic) ∑’˺‘«‡¬◊ËÕ∫ÿ™—ÈππÕ°
(serosal surfaces) ¡’√“¬ß“π°“√æ∫≈—°…≥–
‰μ´’¥¥â«¬
93
 „π ÿπ—¢∑’Ëμ‘¥‡™◊ÈÕ EHEC O157:H7 π—Èπ
‰¡à æ ∫√Õ¬‚√§®“°°“√ºà “ ´“°Õ¬à “ ß¡’ π— ¬
”§—≠ „π ÿπ—¢∑’Ë∂Ÿ°©’¥‡™◊ÈÕ ‡μ√π∑’Ë ‰¡à „ ™à
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
EHEC O157 æ∫«à“ “‡ÀμÿÕ—π¥—∫·√°¢Õß
°“√쓬 §◊ Õ °“√Õÿ ¥ μ— π ¢Õß≈‘Ë ¡ ‡≈◊ Õ ¥„π
À≈Õ¥‡≈◊ Õ ¥¢π“¥‡≈Á ° (microvascular
thrombosis) ∑”„À⇰‘¥‰μ«“¬ ·≈–Õ«—¬«–
À≈“¬Õ¬à“߇ ’¬À“¬ °≈ÿà¡Õ“°“√π’È¡’§«“¡
§≈⓬§≈÷ß°—∫°≈ÿà¡Õ“°“√ HUS „π ÿπ—¢
‡À≈à“π’Èæ∫°“√Õ—°‡ ∫·≈–°“√∫«¡πÈ”‡°‘¥
¢÷È π ∑’Ë ≈”‰ â ‡ ≈Á ° ·≈–≈”‰ â „ À≠à æ∫‰μ´’ ¥
√à«¡°—∫æ∫®ÿ¥‡≈◊Õ¥ÕÕ°¢π“¥‡≈Á°∑’˺‘«‡¬◊ËÕ∫ÿ
™—ÈππÕ° μ—∫¢¬“¬„À≠à√à«¡°—∫¡’√Õ¬‚√§¢Õß
°“√Õ—°‡ ∫·≈–‡π◊ÈÕ쓬
°“√«‘π‘®©—¬
‡™◊ÕÈ EHEC ‡ªìπ‡™◊ÕÈ ∑’Ë “¡“√∂μ‘¥μàÕ‰¥â
®“° —μ«å Ÿà§π·≈–¡’ª√‘¡“≥¢Õ߇™◊ÈÕ∑’Ë°àÕ„Àâ
‡°‘ ¥ ‚√§‰¥â Õ ¬Ÿà „ π√–¥— ∫ μË” §«√¡’ § «“¡
√–¡— ¥ √–«— ß ∂â “ ‡¡◊Ë Õ μâ Õ ß¡’ ° “√®— ¥ °“√°— ∫
μ—«Õ¬à“ß ¡’√“¬ß“π°“√μ‘¥‡™◊ÈÕ∑’ˇ°‘¥®“°
ÀâÕߪؑ∫—μ‘°“√
—μ«å∑’ˇªìπæ“À–·∫∫‰¡à· ¥ßÕ“°“√π—Èπ
¡—°μ√«®æ∫‡™◊ÕÈ ·∫§∑’‡√’¬„πμ—«Õ¬à“ßÕÿ®®“√–
´÷ËßÕÿ®®“√–π—ÈπÕ“®‰¥â®“°∑’Ë —μ«å‡æ‘Ëß∂à“¬ÕÕ°¡“
À√◊ Õ ‰¥â ¡ “®“°μ— « — μ «å ‚ ¥¬μ√ß °“√‡°Á ∫
μ— « Õ¬à “ ß‚¥¬„™â ‰¡â æ— π ”≈’ ªÑ “ ¬‡™◊È Õ ºà “ π
√Ÿ ∑ «“√Àπ— ° Õ“®„™â ‰¥â „ π∫“ß°√≥’ ·≈–
“¡“√∂‡°Á ∫ μ— « Õ¬à “ ß∑’Ë Õ ¬Ÿà ¿ “¬„π≈”‰ â ‰¥â
®“°‚√ß¶à“ —μ«å °“√‡°Á∫μ—«Õ¬à“ß´È”π—Èπ‡™àπ
‡¥’¬«°—∫°“√‡°Á∫μ—«Õ¬à“ß„π —μ«åÀ≈“¬μ—«®–
‡æ‘Ë¡‚Õ°“ „π°“√μ√«®æ∫‡™◊ÈÕ¡“°¬‘Ëߢ÷Èπ
94
„π∫“ß°“√»÷ ° …“æ∫«à “ μ— « Õ¬à “ ß∂Ÿ ° ‡°Á ∫ ‰¥â
®“°Àπ—ß —μ«åπÕ°‡Àπ◊Õ®“°Õÿ®®“√– „π°“√
»÷ ° …“Àπ÷Ë ß √“¬ß“π«à “ “¡“√∂ ”√«®
∂“π–¢Õ߇™◊ÈÕ EHEC O157:H7 ¢Õß‚§
„πø“√å¡À√◊Õ§Õ°‰¥â ‚¥¬°“√‡¥‘π√Õ∫∫√‘‡«≥
§Õ°‚¥¬ «¡∑’Ë § ≈ÿ ¡ √Õ߇∑â “ ·∫∫„™â ‡ æ’ ¬ ß
§√—È߇¥’¬«∑’Ë “¡“√∂¥Ÿ¥´—∫πÈ”‰¥â (liquid
absorbing overshoes) μ—«Õ¬à“ߧ«√‡°Á∫
∑’ËÕÿ≥À¿Ÿ¡‘‡¬Áπ (4C/39F) ·≈–§«√π”¡“
‡æ“–‡™◊ÈÕ„Àâ‡√Á«∑’Ë ÿ¥‡∑à“∑’ˇªìπ‰ª‰¥â
°“√μ√«®√–∫ÿ‡™◊ÈÕ EHEC π—Èπ∑”‰¥â¬“°
‡™◊ÈÕ‡À≈à“π’ȇªìπ‡™◊ÈÕ°≈ÿà¡πâÕ¬„πÕÿ®®“√–¢Õß
—μ«å ‡™◊ÈÕ‡À≈à“π’Ȭ—ß¡’§«“¡§≈⓬§≈÷ß°—∫‡™◊ÈÕ
E. coli ∑’‡Ë ªìπ‡™◊ÕÈ Õ‘ßÕ“»—¬¬°‡«âπ„π‡√◊ÕË ß°“√
√â“ß verocytotoxin Õ¬à“߉√°Áμ“¡ “√æ‘…
verocytotoxin ‡æ’¬ßÕ¬à“߇¥’¬«‰¡à “¡“√∂
„™â√–∫ÿ«à“‡ªìπ‡™◊ÈÕ EHEC ‰¥â ¬—ßμâÕßμ√«®
À“ªí®®—¬°“√°àÕ§«“¡√ÿπ·√߇æ‘Ë¡‡μ‘¡¥â«¬
Àâ Õ ßªØ‘ ∫— μ‘ ° “√„π°“√«‘ π‘ ® ©— ¬ À≈“¬Ê ∑’Ë
“¡“√∂À“‡™◊ÈÕ verocytotoxin-producing
E. coli (VTEC) ·≈–√–∫ÿ ‡ ™◊È Õ EHEC
O157:H7 ‰¥â ‡™◊ÈÕ ‡μ√πÕ◊Ëπ∑’Ë ‰¡à „™à EHEC
O157 μâÕß∂Ÿ° à߉ªÀâÕߪؑ∫—μ‘°“√Õâ“ßÕ‘ß
”À√—∫°“√μ√«®√–∫ÿ‡™◊ÈÕ ‰¡à¡’«‘∏’«‘π‘®©—¬„¥
‡æ’¬ß«‘∏’‡¥’¬«∑’Ë®– “¡“√∂·¬°‡™◊ÈÕ EHEC
∑ÿ°´’ ‚√‰∑ªá ‰¥â
Õ“À“√‡≈’Ȭ߇™◊ÈÕ ”À√—∫‡™◊ÈÕ∑’Ë®”‡æ“–
μà Õ ‡™◊È Õ ·≈–Õ“À“√‡≈’È ¬ ߇™◊È Õ ∑’Ë „ à Õ “À“√
æ‘ ‡ »…‡æ◊Ë Õ °“√§— ¥ ·¬°™π‘ ¥ ¢Õ߇™◊È Õ ∂Ÿ °
æ—≤π“¢÷Èπ¡“ ”À√—∫‡™◊ÈÕ EHEC O157:H7
‚¥¬Õ“»—¬À≈—°°“√∑’‡Ë ™◊ÕÈ ‰¡à¡’ β-glucuronidase
·≈– ‡μ√π¢Õ߇™◊È Õ à « π„À≠à ‰ ¡à “¡“√∂
À¡— ° πÈ” μ“≈´Õ√å ∫‘ ∑ Õ≈‰¥â Õ ¬à “ ß√«¥‡√Á «
¡’§«“¡π‘¬¡„π°“√„™â MacConkey agar
∑’Ë¡’´Õ√å∫‘∑Õ≈ 1% (SMAC) ¡—°„ à√à«¡°—∫
¬“ªØ‘™’«π–‡´øî°´’¡·≈–¡’πÈ”μ“≈·√¡‚π
À√◊Õ‚æ·∑ ‡´’¬¡‡∑≈≈Ÿ‰√μåÕ¬à“ß„¥Õ¬à“ßÀπ÷ßË
Õ“À“√‡≈’¬È ߇™◊ÕÈ hemorrhagic colitis agar
“¡“√∂„™â‡æ◊ËÕ·¬°‡™◊ÈÕ EHEC O157:H7
®“°Õ“À“√‰¥â Õ“À“√‡≈’¬È ߇™◊ÕÈ ™π‘¥Õ◊πË Ê ‡™àπ
Õ“À“√‡≈’Ȭ߇™◊ÈÕ∑’Ë¡’ à«πº ¡¢Õß “√∑’Ë∑”„Àâ
‡°‘¥ ’ ‡™àπ rainbow agar °Á “¡“√∂„™â ‰¥â
‡π◊ËÕß®“° ‡μ√πÕ◊ËπÊ ¢Õ߇™◊ÈÕ E. coli ·≈–
·∫§∑’‡√’¬™π‘¥Õ◊ËπÊ “¡“√∂‡®√‘≠‡μ‘∫‚쉥â
∫πÕ“À“√‡≈’Ȭ߇™◊ÈÕ‡À≈à“π’È °“√‡μ‘¡ “√‡æ◊ËÕ
°“√‡®√‘≠‡μ‘∫‚μ‡©æ“– ”À√—∫ E. coli O157
“¡“√∂™à«¬„π°“√μ√«®·¬°‡™◊ÈÕ‰¥â ‡æ◊ËÕ
™à«¬„À⇙◊ÈÕ‡®√‘≠‰¥â¥’¢÷Èπ Õ“®π”μ—«Õ¬à“ß¡“
‡æ“–‡≈’¬È ß„πÕ“À“√‡≈’¬È ߇™◊ÕÈ ‡À≈«∑’‡Ë μ‘¡ “√
‡æ◊ËÕ‡ √‘¡°“√‡®√‘≠‡μ‘∫‚μ¢Õ߇™◊ÈÕ À√◊Õ„™â«‘∏’
Õ‘ ¡ ¡Ÿ ‚ π·¡Á ° ‡πμ‘ ° ‡æ◊Ë Õ ‡æ‘Ë ¡ §«“¡‡¢â ¡ ¢â π
¢Õ߇™◊ÈÕ·∫§∑’‡√’¬´’ ‚√°√ÿäª O157 °àÕπ∑’Ë®–
π”¡“‡æ“–≈ß„π®“π‡æ“–‡™◊ÕÈ «‘∏Õ’ ¡‘ ¡Ÿ‚π·¡Á°
‡πμ‘ ° π—È π ®–„™â ‡ ¡Á ¥ ·¡à ‡ À≈Á ° ∑’Ë ‡ §≈◊ Õ ∫¥â « ¬
·Õπμ‘∫Õ¥’μàÕ·Õπ쑇®π O157 ‡æ◊ËÕ®—∫°—∫
‡™◊ÈÕ·∫§∑’‡√’¬‡À≈à“π’È
‚§‚≈π’∑’Ë ß —¬«à“®–‡ªìπ‡™◊ÈÕ EHEC
O157:H7 “¡“√∂∂Ÿ°¬◊π¬—π«à“‡ªìπ‡™◊ÕÈ E.coli
‰¥â ® “°°“√∑¥ Õ∫∑“ß™’ « ‡§¡’ · ≈–®–æ∫
°“√· ¥ß¢Õß O157 ‡ªìπ·Õπ쑇®π∫π
ºπ—߇´≈≈å ·≈–æ∫ H7 ‡ªìπ·Õπ쑇®π∫π
·ø°‡®≈≈“‚¥¬«‘∏’∑“ßÕ‘¡¡Ÿ‚π·Õ ‡ ·≈–
«‘∏’∑¥ Õ∫Õ’°¡“°¡“¬√«¡∂÷߇Õπ‰´¡å≈‘ߧå
Õ‘¡¡Ÿ‚π´Õ√å‡∫π∑å·Õ ‡ °“√∑¥ Õ∫ªØ‘°‘√‘¬“
°“√‡°“–°≈ÿ¡à À√◊Õ·Õ°°≈Ÿμ‡‘ π™—πË (agglutination)
«‘ ∏’ ‚æ≈’‡¡Õ‡√ ‡™π√’·Õ§™—Ëπ (PCR) ·≈–
«‘∏Õ’ ¡‘ ¡Ÿ‚π∫≈Õμμ‘ßÈ (immunoblotting) À√◊Õ
Vero cell assay °Á “¡“√∂„™â ‰¥â‡æ◊ËÕμ√«®
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
À“ “√æ‘… verocytotoxin À√◊Õ¬’π∑’Ë √â“ß
“√æ‘… ·≈–«‘∏°’ “√®”·π°·∫§∑’‡√’¬ (phage
typing) ·≈–«‘ ∏’ ° “√·¬°¥’ ‡ ÕÁ π ‡Õ‚¥¬„™â
°√–· ‰øøÑ “ 2 ∑‘ » ∑“ßÀ√◊ Õ æ— ≈ ´å øî ≈ ¥å
‡®≈Õ‘‡≈Á°‚∑√‚ø‡√´‘ (pulsed field gel
electrophoresis) “¡“√∂·¬°´— ∫ ‰∑ªá
¢Õ߇™◊ÈÕ EHEC O157:H7 ‡æ◊ËÕ°“√»÷°…“
∑“ß√–∫“¥«‘∑¬“ «‘∏’‡À≈à“π’È „™â‡ªìπ«‘∏’∑—Ë«‰ª
∑’Ë∑”„πÀâÕߪؑ∫—μ‘°“√Õâ“ßÕ‘ß
«‘∏∑’ ’Ë„™â „π°“√√–∫ÿ‡™◊ÕÈ EHEC O157:H7
Õ“®∑”„Àâæ≈“¥°“√æ∫ ‡μ√πÕ◊πË Ê ∑’Ë ‰¡à§Õà ¬
æ∫‡ªìπª°μ‘ √«¡∂÷߇™◊ÈÕ∑’Ë·¬°‰¥âπâÕ¬¡“°
®“°°“√À¡—°πÈ”μ“≈´Õ√å∫∑‘ Õ≈ «‘∏‡’ À≈à“π—πÈ ¬—ß
‰¡à§àÕ¬¡’ª√– ‘∑∏‘¿“æ„π°“√μ√«®À“‡™◊ÈÕ
EHEC O157:H- ´÷Ëß “¡“√∂À¡—°πÈ”μ“≈
´Õ√å∫‘∑Õ≈·≈–¡’‡Õπ‰´¡å‡∫μ“°≈Ÿ§Ÿ‚√𑇥
(beta-glucuronidase) °“√√–∫ÿ‡™◊ÕÈ EHEC
O157:H- π—Èπ∑”‰¥â¬“°≈”∫“° ·μà “¡“√∂
∑”‰¥â ‚¥¬„™â«∏‘ «’ ∏‘ Õ’ ¡‘ ¡Ÿ‚π·¡Á°‡πμ‘° μ“¡¥â«¬
π”μ—«Õ¬à“߇擖≈ß∫π Sorbitol Mac Conkey
agar (SMAC) ·≈–∑¥ Õ∫°“√À¡—°πÈ”μ“≈
´Õ√å∫∑‘ Õ≈·μà≈–‚§‚≈π’‡æ◊ÕË μ√«®À“·Õπ쑇®π
O157 verocytotoxins À√◊Õ¬’π„π°“√ √â“ß
“√æ‘… ·≈–/À√◊Õªí®®—¬§«“¡√ÿπ·√ßÕ◊ËπÊ
Õ“À“√‡≈’Ȭ߇™◊ÈÕ∑’Ë®”‡æ“–μàÕ‡™◊ÈÕ·≈–
«‘∏’°“√·¬°‡™◊ÈÕ‰¥â¡’°“√æ—≤π“ ”À√—∫‡™◊ÈÕ
∫“ßμ—«„π°≈ÿ¡à ∑’Ë ‰¡à„™à‡™◊ÕÈ EHEC O157 ‡¡Á¥
·¡à ‡ À≈Á ° ¢Õß«‘ ∏’ Õ‘ ¡ ¡Ÿ ‚ π·¡Á ° ‡πμ‘ ° π—È π
¡’®”Àπà“¬„π∑“ß°“√§â“‡æ◊ËÕ‡æ‘Ë¡§«“¡‡¢â¡¢âπ
95
 ¢Õ߇™◊ÈÕ EHEC ∫“ß´’ ‚√°√ÿäª ª√–°Õ∫¥â«¬
O26 O103 O111 ·≈– O145 Õ“À“√
‡≈’¬È ߇™◊ÕÈ rhamnose MacConkey ª√–°Õ∫
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
¥â « ¬¬“ªØ‘ ™’ « π–‡´øî ° ´’ ¡ ·≈–‡∑≈≈Ÿ ‰ √μå
(CT-RMAC) ∂Ÿ°π”¡“„™â „π°“√·¬°‡™◊ÈÕ
EHEC O26 °“√·¬°‡™◊ÈÕ à«π„À≠à¢Õß
°≈ÿ¡à ∑’ˉ¡à„™à‡™◊ÕÈ EHEC O157 Õ“»—¬°“√μ√«®
§— ¥ °√Õß‚§‚≈π’ ”À√— ∫ °“√μ√«® “√æ‘ …
verocytotoxin ¬’π∑’Ë √â“ß “√æ‘…·≈–ªí®®—¬
§«“¡√ÿπ·√ßÕ◊ËπÊ ∑’ˇ°’ˬ«¢âÕß°—∫‡™◊ÈÕ EHEC
Õ“À“√‡≈’¬È ߇™◊ÕÈ MacConkey À√◊Õ™π‘¥Õ◊πË Ê
∑’Ë ‡ §¬„™â ‡ ªì π ª°μ‘ „ π°“√‡æ“–‡≈’È ¬ ߇™◊È Õ
E. coli “¡“√∂π”¡“„™â‡æ“–‡≈’¬È ߇™◊ÕÈ ‡À≈à“π’È
‰¥â‡™àπ°—π «‘∏’°àÕπ°“√μ√«®§—¥°√Õß∫“ß«‘∏’
¡’‡ªÑ“À¡“¬μàÕ´’ ‚√°√ÿäªÀ√◊Õ´’ ‚√‰∑ªá∑’Ë®”‡æ“–
∑’‡Ë ªìπ∑’∑Ë √“∫«à“‡°’¬Ë «¢âÕß°—∫‚√§∑’‡Ë °‘¥®“°‡™◊ÕÈ
EHEC „π§π «‘∏’∑’Ë„™â‡æ◊ËÕ√–∫ÿ‡™◊ÈÕ à«π„À≠à
∑’Ë ‰¡à „™à°≈ÿà¡ EHEC O157 ‡ªìπ«‘∏’∑’Ë¡’§«“¡
¬ÿà ß ¬“°¡“°·≈–«‘ ∏’ ° “√‡À≈à “ π’È ‰¡à ‰ ¥â „ ™â „π
ÀâÕߪؑ∫—μ‘°“√ à«π„À≠à
«‘ ∏’ ∑ “ß¿Ÿ ¡‘ §ÿâ ¡ °— π «‘ ∑ ¬“·≈–«‘ ∏’ μ √«®
À“°√¥π‘ « §≈’ Õ‘ ° ∑’Ë „ ™â μ √«®À“·Õπμ‘ ‡ ®π
O ·≈– H verocytotoxin À√◊ Õ ¬’ π Õ’ °
¡“°¡“¬∑’ˇ°’ˬ«¢âÕß°—∫‡™◊ÈÕ EHEC “¡“√∂
„™â‡æ◊ËÕ«‘π‘®©—¬‡∫◊ÈÕßμâπ «‘∏’°“√∑¥ Õ∫∑’Ë „Àâ
º≈√«¥‡√Á « ‡À≈à “ π’È “¡“√∂„™â æ‘ ® “√≥“
»—°¬¿“æ¢Õ߇™◊ÕÈ °àÕ‚√§∑’æË ∫„πμ—«Õ¬à“ß°àÕπ
∑’®Ë –π”¡“∑”°“√·¬°‡™◊ÕÈ «‘∏‡’ À≈à“π—πÈ ª√–°Õ∫
¥â«¬™ÿ¥πÈ”¬“μ√«®Õ¬à“ß√«¥‡√Á« À√◊Õ¥‘ª μ‘Í°
·≈–‡∑§‚π‚≈¬’‡¡¡‡∫√π «‘∏∑’ ¥ Õ∫ªØ‘°√‘ ¬‘ “
°“√‡°“–°≈ÿà¡ «‘∏’ ‰¡‚§√‡æ≈∑ «‘∏’ ‚§‚≈π’-
Õ‘¡¡Ÿ‚π∫≈Õμμ‘Èß PCR Õ‘¡¡Ÿ‚πø≈ŸÕÕ‡√ ‡´π å
96
·≈– ELISAs ∂÷ß·¡â«à“°“√ √â“ß “√æ‘…
verocytotoxin “¡“√∂™à«¬„π°“√√–∫ÿμ—«
‡™◊ÈÕ‰¥â ‡™◊ÈÕ VTEC ‡ªìπ‡™◊ÈÕ∑’Ëæ∫∫àÕ¬„π —μ«å
·≈–‰¡à®”‡ªìπ∑’ˇ™◊ÈÕ‡À≈à“π’È®–μâÕ߇ªìπ‡™◊ÈÕ
EHEC ·≈–§«√μ√«®√–∫ÿÀ“ªí®®—¬§«“¡
√ÿπ·√ߢÕ߇™◊ÈÕ∑’ˇæ‘Ë¡¢÷Èπ¡“ °“√∑’Ë ‰ ¡à æ ∫
Õπÿæπ— ∏å¢Õß “√æ‘…„π‡™◊ÕÈ EHEC °Á “¡“√∂
‡°‘¥¢÷πÈ ‰¥â º≈¢Õß«‘∏«’ π‘ ®‘ ©—¬∑’√Ë «¥‡√Á« “¡“√∂
μ√«®¬◊π¬—π‰¥â®“°°“√‡æ“–·¬°‡™◊ÕÈ ™ÿ¥μ√«®
”‡√Á®√Ÿª∫“ß™ÿ¥„™â ”À√—∫μ—«Õ¬à“ßÕ“À“√
·≈–‡π◊ÕÈ ·≈–™ÿ¥μ√«® ”‡√Á®√Ÿª ”À√—∫μ√«®
μ—«Õ¬à“ߢÕߧπÕ“®¡’§«“¡‰«‰¡à ‡ æ’ ¬ ßæÕ
‡¡◊ÕË π”¡“„™â∑¥ Õ∫μ—«Õ¬à“ßÕÿ®®“√–®“° μ— «å
∂÷ß·¡â«à“‚§ “¡“√∂ √â“ß·Õπμ‘∫Õ¥’μàÕ
‡™◊ÈÕ O157 «‘∏’∑“ß´’√—Ë¡«‘∑¬“‰¡à ‰¥â¡’°“√π”
¡“„™â‡ªìπª°μ‘„π —μ«å‡æ◊ËÕ«‘π‘®©—¬°“√μ‘¥‡™◊ÈÕ
VTEC À√◊Õ EHEC
°“√ªÑÕß°—π
°“√ªÑÕß°—π°“√¢—∫‡™◊ÈÕ„π —μ«å‡≈’Ȭ߂¥¬
‡©æ“– —μ«å‡§’Ȭ«‡Õ◊ÈÕßπ—Èπ ‡æ◊ËÕÀ«—ß«à“®–
“¡“√∂≈¥®”π«π°“√μ‘¥‡™◊ÈÕ„π§π≈߉¥â
«‘ ∏’ ° “√‡À≈à “ π’È ¬— ß Õ¬Ÿà „π¢—ÈπμÕπ°“√æ—≤π“
°“√«‘ π‘ ® ©— ¬ ·≈–¡ÿà ß ‡πâ π °“√§«∫§ÿ ¡ ‰ª∑’Ë
super-shedders πà“®–‡ªìπ«‘∏∑’ ¡’Ë ª’ √– ∑‘ ∏‘¿“æ
°“√π” super-shedders ÕÕ°®“°ΩŸßÕ“®
™à«¬ªÑÕß°—π‚√§‰¥â „π°“√»÷°…“Àπ÷Ëßæ∫«à“
°“√‰∂·≈–ߥ„™â∑ÿàßÀ≠Ⓡ≈’È¬ß —μ«å„π™à«ßƒ¥Ÿ
Àπ“«®–™à « ¬ªÑ Õ ß°— π °“√μ‘ ¥ μà Õ ¢Õ߇™◊È Õ
EHEC O157:H7 ‰ª Ÿà —μ«å∑’Ë¡’§«“¡‰«√—∫„π
™à«ßƒ¥Ÿ„∫‰¡âº≈‘μàÕ¡“‰¥â ¢âÕ‡ πÕ·π–Õ◊ËπÊ
ª√–°Õ∫¥â«¬°“√©’¥«—§´’π °“√„™âπÈ”¬“
¶à“‡™◊ÈÕ ‡™àπ §≈Õ‡Œ°´‘¥’π (chlorhexidine)
°“√„ ¬à “μâ“π‡™◊ÕÈ ®ÿ≈™’æÀ√◊Õ·∫§‡∑Õ√‘‚Õ‡ø®
∑’Ë∫√‘‡«≥≈”‰ âμ√ß à«πª≈“¬ ·≈–°“√„™â
‚æ√‰∫‚Õμ‘ ° ‡æ◊Ë Õ ™à « ¬‡æ‘Ë ¡ ®”π«π¢Õ߇™◊È Õ
·∫§∑’‡√’¬∑’Ë¥’ „π∑“߇¥‘πÕ“À“√ °“√®—¥°“√
¥â “ πÕ“À“√°Á ¡’ ° “√‡ πÕ·π–‡æ◊Ë Õ ªÑ Õ ß°— π
°“√μ‘¥‡™◊ÈÕ ¢âÕ‡ πÕ·π–‡À≈à“π’Ȭ—ß¡’°“√
«‘®¬— ‡æ‘¡Ë ‡μ‘¡Õ¬Ÿà
°“√®—¥°“√‡æ◊ÕË ≈¥®”π«π‡™◊ÕÈ EHEC „π
ß‘Ë ·«¥≈âÕ¡ ∑”‰¥â ‚¥¬°“√‡°Á∫¢Õ߇ ¬’ ∑’Ë ‰À≈
ÕÕ°¡“Õ¬Ÿ∫à πæ◊πÈ ªŸπ´’‡¡πμ凪ìπ‡«≈“ 3 ‡¥◊Õπ
À√◊Õπ“π°«à“π—Èπ°àÕπ∑’Ë®–ª≈àÕ¬ÕÕ° ·≈–
§«√‡°Á∫¢Õ߇À≈«∑—ÈßÀ¡¥„π∑àÕæ—°πÈ”‡æ◊ËÕ
≈¥°“√ºà“π¢Õß ‘Ëߪؑ°Ÿ≈∑’ˇªìπ¢Õ߇À≈«≈ß
ŸàπÈ”„μâ¥‘π ‡™◊ÈÕ EHEC ∫“ßμ—«Õ“®¬—ß¡’™’«‘μ
Õ¬Ÿà ‰¥âÀ≈—ß°“√‡°Á∫∑’ˬ“«π“π ·≈–¡Ÿ≈∑’Ë®–„™â
‡ªì π ªÿÜ ¬ ·≈–πÈ” ∑‘È ß ∑’Ë ¬— ß ‰¡à ºà “ π°“√¶à “ ‡™◊È Õ
°Á ‰¡à§«√π”¡“„™âª≈Ÿ°º≈‰¡âÀ√◊Õº—°∑’Ë®–π”
¡“°‘π¥‘∫ ‰¡à§«√„Àâ —μ«å·∑–‡≈Á¡À≠Ⓡªìπ
‡«≈“Àπ÷ËßÀ≈—ß®“°∑’Ë¡’°“√ª≈àÕ¬¢Õ߇ ’¬Õ¬Ÿà
∫πæ◊Èπ∑’Ëπ—ÈπÊ ‡æ◊ËÕ°“√ªÑÕß°—π°“√μ‘¥‡™◊ÈÕ
Ÿà —μ«å °“√À¡—°„∫‰¡â À √◊ Õ °‘Ë ß‰¡â À√◊Õ°“√
∫”∫—¥ ‘Ëߪؑ°Ÿ≈°àÕπ∑’Ë®–𔉪‡ªìπªÿܬՓ®
™à«¬≈¥§«“¡‡ ’ˬ߮“°·À≈àßπ’È ‰¥â √–À«à“ß
°“√À¡—° °“√√Õ¥™’«μ‘ ¢Õ߇™◊ÕÈ ‡À≈à“π’·È ª√º—π
°— ∫ ¢π“¥¢Õß°Õß∑’Ë À ¡— ° Õÿ ≥ À¿Ÿ ¡‘ ·≈–
ª√‘¡“≥¢Õ߇™◊ÈÕ «‘∏’∑“ß™’««‘∑¬“Õ◊ËπÊ (°“√
¬àÕ¬·∫∫„™âÕÕ°´‘‡®π·≈–‰¡à „™âÕÕ°´‘‡®π)
°“√∑”·Àâ ß ‚¥¬„™â § «“¡√â Õ π ·≈–/À√◊ Õ
°“√∫”∫—¥¥â«¬ “√‡§¡’ °Á‡ªìπ«‘∏’∑’Ë·π–π”
‡æ◊ËÕ∑”„Àâ¢Õ߇ ’¬®“°ø“√å¡∂Ÿ°∫”∫—¥¶à“‡™◊ÈÕ
°àÕπ∑’Ë®–ª≈àÕ¬≈ß Ÿà ‘Ëß·«¥≈âÕ¡ ¬—߉¡à¡’¢âÕ
√ÿª∂÷ߺ≈°√–∑∫¢Õß°“√∫”∫—¥¥â«¬ “√‡§¡’
μàÕ ‘Ëß·«¥≈âÕ¡
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
«‘∏’°“√‡æ◊ËÕ°”®—¥‡™◊ÈÕ EHEC ®“° —μ«å
‡≈’È ¬ ß∑’Ë μ‘ ¥ ‡™◊È Õ π—È π ¬— ß ‰¡à ¡’ ° “√√“¬ß“π‰«â
Õ¬à“߉√°Áμ“¡ °“√∑”«—§´’π¥â«¬‡™◊ÈÕ ‡μ√π
EHEC ( O145:H-) ºà“π∑“ߪ“° ‚¥¬∑”„Àâ
‡™◊ÈÕ쓬¥â«¬§«“¡√âÕπ “¡“√∂À¬ÿ¥°“√
¢—∫¢Õ߇™◊ÈÕ„π·¡«‰¥â
Õ—μ√“°“√ªÉ«¬·≈–Õ—μ√“°“√쓬
®“°°“√ ”√«®æ∫«à “ ‡™◊È Õ EHEC
O157:H7 ¡’°“√·æ√à°√–®“¬«ß°«â“ß„πΩŸß‚§
·μ৫“¡™ÿ°„π —μ«å·μà≈–μ—«Õ¬Ÿà „π√–¥—∫μË”
∫“ß°“√»÷°…“√“¬ß“π«à“‡™◊ÈÕπ’Èæ∫‰¥â∫àÕ¬„π
‚§√–À«à“ß™à«ßƒ¥Ÿ√âÕπ·≈–μâπƒ¥Ÿ„∫‰¡â√à«ß
¡’°“√»÷°…“Àπ÷Ëß∑’Ë√“¬ß“𧫓¡™ÿ°¢Õß‚√§
«à“ ߟ ¢÷πÈ ‡¡◊ÕË Õ“°“»‡¬Áπ≈ß ·μà‡™◊ÕÈ ·∫§∑’‡√’¬
®–∂Ÿ°¢—∫ÕÕ°¡“¡“°„π™à«ßƒ¥Ÿ√Õâ π °“√»÷°…“
Õ◊ËπÊ æ∫«à“¬—߉¡à¡’√Ÿª·∫∫°“√¢—∫ÕÕ°¢Õß
‡™◊ÈÕ·∫§∑’‡√’¬μ“¡ƒ¥Ÿ°“≈
Õ—μ√“§«“¡™ÿ°¢Õ߇™◊ÕÈ EHEC O157:H7
„π‚§æ∫«à“¡’§«“¡·ª√º—πÕ¬Ÿà „π™à«ßμ—Èß·μà
πâÕ¬°«à“ 1% ∂÷ß 36% ¢÷ÈπÕ¬Ÿà°—∫ª√–‡∑»∑’Ë
‡°‘¥°“√√–∫“¥ ™π‘¥¢ÕßΩŸß —μ«å∑’Ë∑”°“√
»÷°…“ ·≈– ¿“«–Õ◊ËπÊ „π°“√»÷°…“Àπ÷Ëß
§“¥°“√≥å«à“ 28% ¢Õß‚§∑’Ë ‚ √ß¶à “ — μ «å
„π À√—∞Õ‡¡√‘°“¡’‡™◊ÈÕ EHEC O157:H7
„π™à«ßƒ¥Ÿ√Õâ π „π°“√ ”√«®‡¡◊ÕË ‰¡àπ“π¡“π’È
æ∫«à“ 97% ¢Õßß“π®—¥‡‡ ¥ß ‘π§â“°“√
‡°…μ√¢Õߪ√–‡∑» À√—∞Õ‡¡√‘°“®–¡’ —μ«å
Õ¬à“ßπâÕ¬ 1 μ—«∑’Ëμ‘¥‡™◊ÈÕ EHEC O157:H7
97
 ‚¥¬√«¡·≈⫇™◊ÈÕπ’È∂Ÿ°·¬°‰¥â®“°‚§ 11.4%
„π ÿ°√ 1.2% „π·°– ·≈–·æ– 3.6% ·≈–
„πΩŸß·¡≈ß«—π 5.2% ∑’Ëß“π®—¥· ¥ß ‘π§â“
‚√§∑’ˇ°‘¥®“°·∫§∑’‡√’¬
„πÕ—ß°ƒ…¡’°“√ª√–¡“≥§«“¡™ÿ°¢Õ߇™◊ÈÕ
EHEC O157:H7 „π·°–Õ¬Ÿà∑’Ë 2.2 ∂÷ß 7.4%
°“√»÷°…“Àπ÷ßË æ∫«à“¡’§«“¡™ÿ°∑’‡Ë ªìπ§√—ßÈ §√“«
(transient prevalence) ¢Õ߇™◊ÈÕπ’È „π·°–
Õ¬Ÿà∑’Ë 31% °“√»÷°…“‡¡◊ËÕ‰¡àπ“π¡“π’È¢Õß
À√—∞Õ‡¡√‘°“æ∫«à“°√–∑‘߉∫´—π®”π«π¡“°
°Á¡’‡™◊ÈÕ EHEC O157:H7 ‰¥â ¡’§«“¡™ÿ°
∑—ßÈ À¡¥Õ¬Ÿ∑à ’Ë 47% ·≈–¡’§«“¡™ÿ°¢ÕßÕÿ®®“√–
∑’Ëæ∫‡™◊ÈÕ∑’ˇ°Á∫¡“„π«—πμà“ßÊ ·ª√º—πÕ¬Ÿà∑’Ë
17% ∂÷ß 83% §«“¡™ÿ°„π°«“ß∂Ÿ°√“¬ß“π
Õ¬Ÿà∑’ËπâÕ¬°«à“ 3% ·≈–„π∫“ß°“√ ”√«®
æ∫«à“§«“¡™ÿ°πâÕ¬°«à“ 0.5% °“√‡°Á∫μ—«Õ¬à“ß
„π°√–μà“¬ªÉ“∑’Ë¡’§«“¡‡°’ˬ«¢âÕß°—∫ø“√å¡‚§
∑’Ëμ‘¥‡™◊ÈÕ‚¥¬æ∫«à“ 9.5% ∂÷ß 40% ¢Õß
°√–μà“¬¡’‡™◊ÈÕπ’ÈÕ¬Ÿà °“√»÷°…“Àπ÷Ëß√“¬ß“π«à“
„π≈”‰ â „À≠à à«π‚§≈Õπ¢Õß ÿ°√∑’ˇ°Á∫¡“
®“°‚√ß¶à“ —μ«å®”π«π 2% ¡’‡™◊ÈÕ·∫§∑’‡√’¬
EHEC O157:H7 °“√»÷°…“‡¡◊Ë Õ ‰¡à π “π
¡“π’È ‚¥¬°“√„™â«‘∏’∑’Ë¡’§«“¡‰«„π°“√μ√«®
À“‡™◊ÈÕ‰¥â√“¬ß“π∂÷ߧ«“¡™ÿ°∑’Ë Ÿß¡“°¢÷Èπ
°«à“°“√ ”√«®„π™à«ß·√°Ê Õ¬à“߉√°Áμ“¡
«‘∏’°“√∑¥ Õ∫∑’Ë¡’§«“¡‰« Ÿßπ—ÈπÕ“®‰¥â§à“
§«“¡™ÿ°∑’Ë Ÿß‡°‘𧫓¡‡ªìπ®√‘ß ‡π◊ËÕß®“°
—μ«åÕ“®¡’°“√¢—∫ÕÕ°¢Õ߇™◊ÈÕ·∫§∑’‡√’¬·μà
‰¡àæ∫°“√‡æ‘¡Ë ¢Õß®”π«π‡™◊ÕÈ „π√à“ß°“¬ μ— «å
·μàæ∫‡æ’¬ß·§à „π°“√μ‘¥‡™◊ÈÕ·∫∫™—Ë«§√“«
‚¥¬°“√μ‘¥μàÕ®“° super-shedders À√◊Õ
®“° ‘Ëß·«¥≈âÕ¡
98
§«“¡™ÿ°¢Õ߇™◊ÈÕ à«π„À≠à¢Õß°≈ÿà¡∑’Ë ‰¡à „™à
EHEC O157 π—Èπ¬—߉¡à‡ªìπ∑’Ë∑√“∫¡“°π—°
°“√»÷°…“Àπ÷Ëß√“¬ß“π§à“‡©≈’ˬ¢Õߧ«“¡™ÿ°
¢Õ߇™◊ÕÈ VTEC (‰¡à„™à‡™◊ÕÈ EHEC) Õ¬Ÿ∑à ’Ë 31%
„π‚§ ·≈–∑’Ë 42% „π·°– Õ¬à“߉√°Áμ“¡
¡’§«“¡‡ªìπ‰ª‰¥â«à“¬’π∑’Ë¡’§«“¡‡°’ˬ«¢âÕß°—∫
‡™◊ÈÕ EHEC (eaeA) ∂Ÿ°æ∫„π‡™◊ÈÕ∑’Ë·¬°‰¥â
®“°‚§ (16.5%) ¡“°°«à“ ·≈–‡™◊ÈÕ VTEC
„π·°– (7.5%)
¥Ÿ‡À¡◊Õπ«à“‡™◊ÈÕ EHEC ∑’Ë¡’ª√– ‘∑∏‘¿“æ
®–æ∫‰¥â ‰¡à¡“°„π μ— «å «à π„À≠à∑’Ë ‰¡à „™à μ— «å
‡§’¬È «‡Õ◊ÕÈ ß ·≈–æ∫«à“§«“¡™ÿ°¢Õ߇™◊ÕÈ VTEC
„π ÿπ—¢ ·¡« ‰°à ·≈– ÿ°√μË”°«à“„π —μ«å
‡§’Ȭ«‡Õ◊ÈÕß ‡™◊ÈÕ EHEC O153 §àÕπ¢â“ßæ∫
‰¥â∫àÕ¬„π°√–μà“¬ „π°“√»÷°…“Àπ÷Ëßæ∫«à“
25% ¢Õß°√–μà“¬æ—π∏ÿ¥å ™— ∑å (Dutch belted)
·≈– 9% ¢Õßæ—π∏ÿåπ‘«´’·≈π¥å ‰«∑å (New
Zealand white) ®“°·À≈àߧⓇ™‘ßæ“≥‘™¬å
¡’‡™◊ÈÕ EHEC O153:H- À√◊Õ O153: H7 „π
Õÿ®®“√–
°“√ªÉ«¬„π —μ«å‡§’Ȭ«‡Õ◊ÈÕß∑’Ë ‚μ‡μÁ¡∑’Ë¡’
πâÕ¬¡“° À√◊Õ‰¡àæ∫‡≈¬ „π —μ«åÕ“¬ÿπâÕ¬
Õ“®‰¥â√∫— º≈°√–∑∫®“°∫“ß´’ ‚√°√ÿªä ¢Õ߇™◊ÕÈ
EHEC ¡’ √ “¬ß“π°“√쓬„π∫“ß°“√
∑¥≈Õß∑’Ë∑”„Àâ —μ«åμ‘¥‡™◊ÈÕ√«¡∂÷ß„π≈Ÿ°‚§
∫“ßμ—« ÿπ—¢∑’Ë ‰¥â√—∫‡™◊ÈÕ°≈ÿà¡∑’Ë ‰¡à„™à EHEC
O157 ·≈–°√–μà“¬∑’ˉ¥â√∫— ‡™◊ÕÈ EHEC O153
¡’Õ—μ√“°“√ªÉ«¬ ·≈–Õ—μ√“°“√쓬¬—߉¡à‡ªìπ
∑’Ë∑√“∫·πà™—¥
·À≈àߢâÕ¡Ÿ≈∑“ßÕ‘π‡∑Õ√å‡πÁμ
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