Tourists with respiratory problems are likely to have a cosmopolitan illness. Sometimes an exotic disease will be responsible. Remember that typhoid fever often begins with cough and fever, but there will be no stomatitis or pharyngitis. It should be determined whether:

• the disease is acute or chronic
• whether the patient is febrile or afebrile
• whether there is eosinophilia or not
• whether the condition concerns the upper or the lower airways

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In cases of severe inflammation or soreness of the throat one should suspect:

• Viral infections, which are the most frequent.
• Herpangina (Coxsackie virus). This viral infection causes typical lesions on the soft palate.
• Mononucleosis. Often a typical blood picture. Serology carried out on paired sera or detection of IgM will confirm the diagnosis. Mild splenomegaly can occur.
• Mycoplasma pneumoniae infections are cosmopolitan.
• Gonococcal pharyngitis occasionally causes moderate sore throat. Cultures are essential. The partner(s) should likewise be treated.
• Streptococcal angina ("strep throat"). There is a risk of acute rheumatic fever and glomerulonephritis. These complications still occurs frequently in tropical areas.
• Plaut-Vincent angina, caused by infection with Borrelia vincenti, in association with fusobacteria. Penicillin with metronidazole form the preferred therapy.
• Quinsy (paratonsillar abscess) is usually caused by streptococci or by anaerobic bacteria. It is a medical emergency because of the danger of asphyxiation. Drainage of the pus is imperative.
• Diphtheria. Corynebacterium diphtheriae. Pharyngeal diphtheria with cardiac and neurological problems is a very serious disease. There is substantial lymphadenopathy. The incidence of the disease increased greatly during the 1990s in the countries of the former Soviet Union.
• Lassa and Ebola fever. Rare. Sore throat, fever and haemorrhagic tendency are present. These diseases are very rare but are included in the differential diagnosis in tourists from Africa.
• Oropharyngeal anthrax, tularaemia and plague are rare. There is local necrosis and regional lymphadenopathy. Treatment with high doses of penicillin (anthrax), streptomycine (plague) or other antibiotic regimens.
• Agranulocytosis, e.g. after use of amodiaquine or chloramphenicol. A blood test is essential and suggests the diagnosis; a bone marrow biopsy will confirm aplasia.
• In aphthous stomatitis, the use of paludrine (proguanil) should be determined. Malarone contains proguanil.
• It should be borne in mind that secondary syphilis can cause mucosal lesions.
• Halzoun can mimic acute pharyngitis. Linguatula larvae migrate via the oesophagus into the throat, where they firmly attach themselves. Physical examination reveals the parasite.
• Foreign bodies such as fish bones or chicken bones.
• Noma is a dramatic occurrence, clinically obvious.
• Multibacillary leprosy can be accompanied by oral / nasal lesions and hoarseness.
• Do not forget neoplastic lesions as a cause of chronic ulcerations.
• Behçet syndrome can provoke mucosal ulcerations.