Clinical manifestation

Abrupt onset of fever, headache, vomiting, malaise, chills, and sore throat, with rash appearing after 1-4 days; exudative tonsillitis a common site of infection; mucous membranes usually bright red; scattered petechiae and small, red papules on soft palate; during first days of infection, white membrane coating on tongue through which edematous, red papillae protrude (white strawberry tongue); after white membrane sloughs, tongue red with prominent papillae (red strawberry tongue);

exanthem consisting of fine red, punctate papules, appearing within 1-4 days following the onset of illness; first appear on upper trunk and axillae and then generalize, with accentuation in flexural areas; may appear more intense at dependent sites and sites of pressure, such as the buttocks; sandpaper feel to affected skin; transverse areas of hyperpigmentation with petechiae in the axillary, antecubital, and inguinal areas (Pastia lines); flushed face with circumoral pallor; rash fades with fine desquamation after 4-5 days

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