Anicteric viral hepatitis is a widely discussed but little studied entity. Its existence has been acknowledged for many years on the basis of epidemiological and clinical data, mostly indirect and inferential. For example, during epidemics when the hepatitis infection rate is high, cases in which clinical evidence of hepatitis develops without jaundice are often diagnosed as anicteric hepatitis. In addition clinicopathological studies have been done on patients in whom chronic liver disease developed without jaundice or with the late appearance of jaundice. The diagnosis of anicteric hepatitis was made retrospectively. The military population of Taiwan offers advantages to the study of anicteric hepatitis because large numbers of military personnel are concentrated in certain localities and because Taiwan. as an island is a type of closed environment in which follow-up observation is relatively easy. In the present study cases of anicteric hepatitis were detected in military men by the serum glutamic pyruvic transaminase test. this report describes the findings of serial clinical, laboratory and pathological studies performed on these patients with anicteric hepatitis for more than a year.
MATERIALS AND METHODS
Approximately 3500 Taiwanese and Chinese sailors and marines in training schools and marine battalions and on ships were randomly screened. All men were essentially asymptomatic at the time of bleeding and were carrying out routine duties. The serum glutamic pyruvic transaminase test was used as the screening procedure since elevation of this enzyme in the blood is both quite sensitive and a fairly specific measure of hepatcasellular necrosis. Determinations of serum glutamic oxalacetic transaminase were made simultaneously on most blood specimens for comparison. Blood was centrifuged, serum was refrigerated, and enzymes were determined within two or three days of bleeding. Tests were done on fasting blood, and care was taken to avoid hemolysis. If a serum glutamic pyruvic transaminase level of 40 units or above was found the test was repeated within ten days. If the level persisted above 40 units, the subject was taken to the United States Naval Medical Research Unit No. 2 (NAMRU-2) for liver biopsy. Eighty-one of the 9.529 men screened (2.3 per cent) had sustained serum elevations of the enzyme (40 units or above) as judged by 2 separate determinations made within ten days. Sixty-six of this group of ill men had liver biopsies. Some type of liver lesion was observed in 63 of the 66. The lesions were as follows: viral hepatitis without evidence of chronicity.