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Scarlet fever is an exotoxin-mediated disease that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throat, fever, a 'strawberry' tongue, and a fine sandpaper rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is the autoimmune disease that occurs after infection with Group A strep).