A 10 year old girl presents with symptoms shown in the image

A 10 year old girl presents with symptoms shown in the image. She has been suffering from sore throat and fever for last 4 days and rashes started appearing on her neck two days back. All are true regarding the diagnosis except

  1. Blood culture remains the criterion standard for confirmation of the disease

  2. Occurs as a result of a group A Streptococcus infection

  3. The characteristic rash is due to the erythrogenic toxin

  4. The blood test shows elevation of antistreptolysin O titer

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