A patient in the second week of a febrile illness presents with a fever that gradually increases each day, reaching a high plateau. This characteristic fever pattern in typhoid fever is known as:?

Appeared in: AIIMS BHOPAL NO- 2018( Shift-2nd)

Explanation

Step-ladder pyrexia is the classic fever pattern associated with the initial stages of typhoid (enteric) fever.
This pattern is characterized by a gradual, stepwise increase in body temperature each day, with the peak temperature being higher than the previous day's.
By the second week, this progressive rise culminates in a sustained high fever, often around 39–40°C (103–104°F).
This pattern reflects the systemic invasion of the bloodstream by the Salmonella Typhi bacteria.

Option A: In an intermittent fever, the temperature returns to a normal baseline at least once within a 24-hour period. The question describes a fever that gradually increases without returning to normal.
Option C: In a remittent fever, the temperature fluctuates (typically by more than 1°C) over 24 hours but consistently remains above normal. While typhoid can become remittent, the key descriptor in the question is the gradual daily ascent, which specifically defines the step-ladder pattern.
Option D: Pel-Ebstein fever is a rare and distinct pattern involving cycles of high fever lasting for several days or weeks, followed by afebrile periods of similar duration. This is not the pattern described.

Clinical Relevance

Nursing practice connection: Use the key finding related to Fever patterns in infectious diseases to guide bedside assessment, documentation, and the next nursing action.
Recognizing fever patterns is a key nursing assessment skill that aids in differential diagnosis. A step-ladder pattern should immediately raise suspicion for typhoid fever, especially with a relevant travel or exposure history.
For a patient with suspected typhoid, nurses must implement enteric precautions (strict hand hygiene, safe disposal of feces) as the disease is spread via the fecal-oral route.
A critical nursing responsibility is to monitor for complications of typhoid, such as intestinal hemorrhage or perforation, which can present with sudden drops in temperature, abdominal pain, and signs of shock.

How to Approach the Question

First, identify the key clinical information in the stem: the diagnosis is likely typhoid fever, and the core finding is a fever that 'gradually increases each day' to a 'high plateau'.
Analyze the term 'gradually increases each day'. This suggests a stepwise or incremental rise.
Evaluate the options based on their definitions. 'Step-ladder' is a metaphor that perfectly matches the description of a gradual, stepwise increase.
Recall or look up the definitions of the other fever types to confirm they do not fit the description.
Intermittent fever returns to normal. Remittent fever fluctuates but doesn't have the characteristic stepwise rise. Pel-Ebstein is cyclical over weeks.
Conclude that 'Step-ladder pyrexia' is the most precise term for the pattern described in the context of typhoid fever.

Concept Tested & Keywords

QZXHDd17yg_CaIuVai6JZw

E6 Nutrition Kumud Khanna 2e p. 196-198

E6 Nursing Fundamentals Taylor p. 118-120

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1642-1644

Practise the full AIIMS BHOPAL NO- 2018( Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.