Lviv clinical bulletin 2017, 1(17): 53-59

https://doi.org/10.25040/lkv2017.01.053

Pneumonia in Children: Pharmacogenetic Aspect in the Appearence of the Severe Forms and Complications of the Disease (Literature Review and Clinical Case Presentation)

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S. Nyankovskyy1, R. Furtak1, M. Yatsula1, O. Shpychka2

1Danylo Halytsky Lviv National Medical University

22nd Lviv City Community Children’s Clinical Hospital

Introduction. Respiratory system diseases were and continue to be a topical problem of the medicine overall and pediatrics in particular. Pneumonia is the most serious disease that kills children under 5 years old globally, taking about 1 million lives every year.

Purpose of the study. To analyze the domestic and foreign literary sources of information dedicated to the role of pharmacogenetics in appearances of the severe forms and complications of pneumonia in children and also to describe a clinical case.

Materials and research methods. Content­analysis, methods of systemic and comparative analysis, biblio semantic method of the actual scientific researches study about the role of pharmacogenetics in appearence of severe forms and pneumonia complications in children, analysis of a case of the disease of a particular patient who was under our observation. Source searching was done with the scientometric databases of medical information: PubMed­NC­BI, Medline, CochraneLibrary, EMBASE, ResearchGate using keywords: pneumonia, children, pharmacogenetics, xenobiotic biotransformation genes. In all, 41 sources in English, Russian and Ukrainian languages were analyzed.

Results of the analysis. Pneumonia is an acute infectious inflammatory disease of the lung parenchyma, characterized by the infiltrative changes in lung tissue and respiratory failure.

A lot of microorganisms can be a reason for pneumonia occurrence. Among the most common bacteria pathogens are: Streptococcus pneumoniae, Haemophilus influenzae type B, and among viruses it’s Human respiratory syncytial virus.

Despite the timely diagnosis and an appropriate drug therapy the number of severe forms and complications of pneumonia is not being reduced. A lot of scientific studies of this topic during the last years are aimed at genetics exploration. Particularly, the area of pharmacogenetics is interesting and perspective part of it.

About 50 % of adverse responses to drugs are caused by the genetic factors. Study of pharmacogenetic impact can serve as a basis for a creation of the individualized approach to the choice of treatment tactics and to the dosage regime. Genetic polymorphisms of xenobiotic metabolism determines the division of people into groups that differ in their ability to metabolize drugs from insufficient to ultrafast metabolisers. Genetic polymorphisms of xenobiotic metabolism can be the reason for occurrence of severe forms and complications of various diseases, including pneumonia in children. These genes include: glutathione transferases (GSTM), O­ and N­acetyltransferases (OAT, NAT1, NAT2) and others.

Among the proteins which affect the speed of excretion of the pharmacological agents the special place belongs to P­glycoprotein, encoded by the gene MDR1. The research results of different authors showed that genetic polymorphism of MDR1 can be an important factor that determines the predisposition to various diseases and resistance to treatment.

Conclusions. The researches of genes involved in the distribution, biotransformation and excretion of toxic products of decay of drugs, is a promising and important component of the pathogenesis and, accordingly, the diagnosis and treatment of pneumonia in children.

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