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

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

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.


  1. Gnateyko O, Lukyanenko N. Ecogenetical aspects of human pathology сaused by impact of harmful environmental factors. Child’s Health. 2007;6:82-87. (Ukrainian).
  2. Grebenyk L, Vysostkyy I. Lectures on biochemistry. In: Biochemistry of the liver. Sumy: Sumy State University, 2011. (Ukrainian).
  3. Zalyzyuk AA. Features of the modern flow of community acquired pneumonia and their treatment in infants [dissertation]. Kharkiv, 2011. 20 p. (Ukrainian).
  4. Sychev D, Ignatyev I, Ramenskaya G et al. The value of polymorphism of gene MDR1, that coding glycoproteinP, for the individualization of drug therapy. Clinical Pharmacology and Therapeutics. 2005;14:1-5. (Russian).
  5. Kech N. Determination of the biochemical activity of the enzyme Nacetyltransferase, producing gene NAT2 in children with ecopatology after the therapy. Child’s Health. 2016;1:68-71. (Ukrainian).
  6. Kresyun V, Bazhora Yu. Pharmacogenetical bases of interaction of the body and drugs. Odesa: Odesa state medical university, 2007. 164 p. (Ukrainian).
  7. Levkovych N, Gorovenko N. Evaluation of distribution of polymorphisms C3435T of gene MDR1 in the population of Ukraine. Actual Problems of Obstetrics and Gynecology, Clinical Immunology and Medical Genetics. 2010;19:282-292. (Ukrainian).
  8. Maydannyk V. Antibiotic therapy of community acquired pneumonia: review of current clinical guidelines. Child’s Health. 2015;1:13-16. (Ukrainian).
  9. Maydannyk V, Smiyan O, Bynda T. Acute pneumonia in children: Clinical variants of flow, diagnosis and treatment: Sumy: Sumy State University, 2009. 156 p. (Ukrainian).
  10. Grechanina O, Hoffmann G, Bogatyrova R et al. Medical genetics: textbook for students of higher medical (pharmaceutical) educational institutions III­IV levels of accreditation. Kyiv: Medicine, 2007. 534 p. (Ukrainian).
  11. Lytvynets L, Synoverska O, Gnateyko O, Vishtak N. Molecular genetic basis and strategy of analysis of asthma in children. Child’s Health. 2012;7:85-89. (Ukrainian).
  12. Pavlyshyn G, Sarapuk I. Oxidative stress in children of early age with community acquired pneumonia. Pediatrics, Obstetrics and Gynecology. 2012;4:25-28. (Ukrainian).
  13. Pishak V, Bulyk R. Basics of pharmacogenetics. Chernivtsi: Medical University, 2006. 144 p. (Ukrainian).
  14. Bragina E, Freydin M, Ten I, Ogorodova L. Polymorphism of xenobiotic metabolism genes GSTT1, GSTM1, CYP2E1 and CYP2C19 in patiens with atopic asthma. Bulletin SB RAMS. 2005;3:121-125. (Russian).
  15. Sarapuk IM. Clinical and pathogenetic and diagnostic value apoptotic activity and oxidative stress in children of early age with community acquired pneumonia [dissertation]. Ternopil, 2013. 20 p. (Ukrainian).
  16. Tsymbalista O, Erstenyuk G, Gavrylyuk O. Correction of violations of prooxidantantioxidant system in children with complicated communityacquired pneumonia. Perinatology and Pediatrics. 2011;4:73-75. (Ukrainian).
  17. Shevchuk O. The markers of hypoxia and inflammation activity in the blood serum of children with community acquired pneumonia depending on the risk of mortality. Journal of Morphology. 2013;19(2):398-402. (Ukrainian).
  18. Esposito S, Patria MF, Tagliabue C, Longhi B, Papa SS, Fondazione NP. CAP in children. Eur Respirat Monograph. 2014;63:130-139.
  19. Kimberly SS, Burton LH, Christa MG. Community aguired pneumonia in children. Am Fam Physician. 2012;86(7):661-667.
  20. Pneumonia still responsible for one fifth of child deaths. World Health Organization. Joint news release: WHO, UNICEF, GAVI Alliance. Geneva, 2013. Available from:­ pneumonia­day­20131112/en/.