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reaction to erythrogenic toxins produced by Group A haemolytic streptococci (usually Streptococcus pyogenes).
more common in 2-6y (peak at 4yr)

Incubation 2-4 days
features - fever, malaise, tonsillitis, 'strawberry' tongue, rash 
rash - fine punctate erythema ('pinhead') starts torso and spares face (may have flushed cheeks with perioral pallor) 
rash may have rough 'sandpaper' texture. 
Desquamination occurs late - esp fingers and toes

''Diagnosis'' - throat swab taken but don't wait Rx for results

''Management''
    oral penicillin V or azithromycin
    can return to school 24 hours after commencing antibiotics
    notifiable disease

''Complications''
    otitis media (commonest)
    rheumatic fever (20/7 post infection)
    acute glomerulonephritis (10/7 post infection)