When a character is injured by a contaminated attack, touches an item smeared with diseased matter, or consumes disease-tainted food or drink, he must make an immediate Fortitude save. If he succeeds, the disease has no effect — his immune system fought off the infection. If he fails, he takes damage after an incubation period. After a set period (which varies by disease), he must make a successful Fortitude save to avoid repeated damage. The number of successful saves required varies by disease, as noted below.
These Fortitude saving throws can be rolled secretly so that the player doesn’t know whether the disease has taken hold.
Disease Descriptions
Diseases have various symptoms and are spread through a number of vectors. The characteristics of several typical diseases are summarized on Table 1: Diseases and defined below.
Name: The disease’s name and any nicknames or colloquial names.
Description: The disease's description, including where it is most prevalent and how often it appears.
Frequency: How common the disease is.
Common: The disease is well-known and widespread - typically, Common diseases are fairly weak
and have a large number of mutations. Examples: The common cold, influenza.
Uncommon: The disease is less prevalent, or localized to a certain climate or geographical area. Examples: Cholera, typhoid, yellow fever.
Rare: The disease is not very well known and usually only in a specific area or climate; rare
diseases usually have a high mortality rate and appear in isolated outbreaks that are usually
quickly isolated. Examples: Ebola, Marburg virus.
Very Rare: The disease has been nearly wiped out, or has a low incubation period and very high mortality rate. In a fantasy realm, very rare diseases are most often magical or divine in origin. Examples: Lhasa fever.
Severity: The diseases in this book are divided into various degrees of severity.
Mild: Almost anyone can get over the disease with little problem, even without any other aid. Examples: The common cold.
Moderate: The disease requires a week or so of bed rest, but victims can recover with minimal healing. Old and young victims often die from this disease without treatment. Examples: Influenza, pneumonia.
Severe: The disease is fatal more often than not, and often those who do survive are crippled or disfigured in some fashion. This class is also used for non-fatal diseases that cause permanent injury (blinding sickness, e.g.). Recovery without healing or magical aid is very rare. Examples: Tuberculosis, polio.
Fatal: 90%+ of victims who contract these diseases die, and very few of those who survive do so unscathed. These diseases often reach epidemic proportions, wiping out towns, cities, or even entire nations before they are contained. Examples: Cancer, Ebola virus, rabies.
Note that any disease can be fatal under the right circumstances, particularly if left untreated. These classifications are rough guidelines and can change according to the circumstances under which the disease is contracted.
Vector: How the disease is spread - through the air (airborne), casual or sexual contact (including contact with bodily fluids), ingested (through contaminated food and/or water), or injury (from dirty claws or bites, or infected objects).
DC: The DC required for the Con check to avoid or throw off the effects of the disease. The initial save to determine infection should be made secretly by the DM, so the player doesn't know that whether the character has been infected or not.
The save DC is based on the disease's severity. Also, diseases require a certain number of successful checks to recover. These checks need not be consecutive, but each success counts toward the total required. The DCs given below are rough guidelines for the DM for creating new diseases.
| Severity | DC | Checks |
|---|---|---|
| Mild | 10 | 2 |
| Moderate | 14 | 3 |
| Severe | 18 | 4 |
| Fatal | 22 | 4 |
Generally speaking, a save should be made a) when the character is first exposed, and b) at each interval, as stated in the disease's entry. If the second save fails, the victim either remains sick or advances to the next stage of the disease, as applicable.
For example, the first stage of blinding sickness lasts for 1d4 days; the victim would make his second save 24 hours after first contracting the disease, and every 24 hours thereafter (if the first stage lasts longer than 1 day). He would make a third save at the end of the time determined for that stage’s duration to see if he becomes sicker.
Incubation Period: The period of time between infection and first manifestation of symptoms.
Effects: A description of the symptoms, if any, and how long they last. This entry also covers all the stages. The first stage lasts until the victim fails a second Con check, unless otherwise stated. The second and third stages' durations are listed in the disease description.
Victims regain one ability point per day of complete rest, so someone who takes small amounts of damage and makes his Con checks could easily ride out a disease with no ill effects. A successful Con check indicates that the victim takes no damage for that time increment (if applicable).
Several diseases listed in this book cause delirium, coma, and death, which often occur regardless of the victim’s stat scores (see ability damage, DMG, Chapter 8).
Cures: Unless otherwise noted, all diseases can be cured with a cure disease spell or a heal, limited wish, or other similar magics. This entry also covers plants, unguents, teas, etc. that can mitigate the disease's effects or cure it outright.
Special: Any special effects, like the victim rising as a zombie if he dies, the body is still infectious after death, etc. This also covers special notes, like races that are immune.
Raising or resurrecting someone who died from a disease is not a good idea, because the virus or bacteria that caused the disease in the first place will most likely still be present in the blood or flesh. If the body is still mostly intact, the victim must also make a Con check at the same DC as before or become sick again with the same disease that killed him. This does not apply for bodies that have been mostly destroyed (especially by fire) or rotted, since the pathogens are no longer present, except in special circumstances.
There are several ways to prevent the spread of disease. Foremost among them - and the most common method - is burning the bodies of the infected dead. Less common, though perhaps more thorough, is destruction of the bodies by magical means – disintegration, acid, etc.
Table 1: Diseases
| Disease | Frequency | Severity | Vector | DC | Incubation |
|---|---|---|---|---|---|
| Blinding sickness | Common | Moderate | Ingested | 15 | 1d3 days |
| Cackle fever | Uncommon | Moderate | Inhaled | 17 | 1 day |
| Demon fever | Rare | Severe | Injury | 18 | 1d4 hours |
| Devil chills | Rare | Moderate | Injury | 16 | 1d4 days |
| Ghoul fever | Uncommon | Severe | Injury | 18 | 3d8 hours |
| Filth fever | Common | Mild | Injury | 12 | 1d3 days |
| Mummy rot | Uncommon | Fatal | Contact | 22 | 1 minute |
| Red ache | Common | Moderate | Injury | 15 | 1d3 days |
| Shakes | Rare | Mild | Injury | 13 | 1 day |
| Slimy doom | Very rare | Fatal | Contact | 25 | 1d4 hours |
1 Successful saves do not allow the character to recover from mummy rot; only magical healing can save him.
Blinding Sickness
Blinding sickness is a much-feared disease spread in water tainted by rotting bodies – animal, human, or otherwise. Victims are easy to spot, as they are blind in one or both eyes. The bacteria attack the optic nerve, eating away at the connection between the eye and the brain, eventually rendering the victim completely blind.
Frequency: Common
Severity: Severe
Vector: Ingested
DC: 16
Incubation Period: 1d3 days
Effects: Those who recover from blinding sickness often suffer from degraded vision or even blindness in one or both eyes. Since the disease attacks the optic nerve and not the eyes themselves, its effects are not visible.
First Stage: The victim runs a low fever and has an itching sensation in one or both eyes, accompanied by redness. This stage lasts for 1d4 days.
Second Stage: The victim's vision is increasingly impaired as the bacteria affect the optic nerves. This manifests as a -4 penalty to Search and Spot checks per day the disease progresses. This stage lasts for 2d6 days, at the end of which he goes blind in one or both eyes (roll a d20 – 1-10 one eye, 11-20, both eyes).
Cures: —
Special: Blindness caused by this disease can be healed with a cure blindness/deafness spell.
Cackle Fever (The Shrieks)
Cackle fever, also known as "the shrieks," is believed to be spread by the spores of certain fungi. The spores are known to be used by several small, primitive jungle tribes as a hallucinogen in extremely small doses mixed with other substances. The spores get into the victim's airways and from there into the bloodstream, making their way to the brain over the course of the next 24 hours, where they infect the nerve centers controlling involuntary muscle control and higher thought processes.
Frequency: Uncommon
Severity: Severe
Vector: Inhaled
DC: 16
Incubation Period: 1 day
Effects:
First Stage: The victim often displays a low-grade fever (100 degrees) and appears disoriented. Other common symptoms are chills, headache, dizziness, and an inability to focus on a given task for more than a few minutes at a time. This stage lasts for 1d3 days.
Second Stage: The fever shoots up to 103-104, and the victim falls into a delirious stupor marked by periods of hideous cackling laughter as his stomach muscles involuntarily contract. He takes 1d4 points of Wisdom damage per failed save during this stage. (Saves are made every 12 hours, instead of once per day.)
Third Stage: If the victim is reduced to 0 Wisdom, he falls into a coma and dies in 3d6 hours, unless cured, as the heart and diaphragm cease to function from massive fatigue.
Cures: The poison from certain jungle tree frogs is known to cause paralysis. This poison, diluted and mixed into a tea, then drunk, relaxes the victim and grants the body a chance to fight the effects of the spores (in effect, this grants a new save at +4). The tea cannot be drunk more than once per day, or the cumulative effects combined with the disease itself interfere with involuntary muscle control, like breathing and heartbeat, causing the heart and lungs to shut down (which ultimately results in death 1d4 hours after the second dose is applied).
Special: —
Demon Fever (Hag’s Kiss)
Demon fever, or hag's kiss, is a rare but much-feared infection spread by the bite of night hags. Victims of demon fever report horrible nightmares in which they are ridden every night by the hag that bit them; as the nightmares progress, they waste away from lack of sleep and the ability to keep down food, eventually dying if the disease is not cured. The souls of those who die are seized by the night hag who infected them, to be used as currency in the Lower Planes, which also prevents their resurrection.
Frequency: Rare
Severity: Severe
Vector: Injury (bite)
DC: 18
Incubation Period: 1d4 hours
Effects:
First Stage: The first symptoms of demon fever often manifest as redness around the bite, accompanied by pain and swelling. During this stage, which lasts for 24 hours, it feels like a low-grade infection.
Second Stage: The victim begins suffering horrible nightmares in which he is ridden all night by the hag that bit him. After the second such night of this, the victim suffers from an inability to concentrate due to lack of sleep (-2 penalty to Concentration checks, +1 per night), and has the faint scent of brimstone about him. The victim must make a Fort save each night or suffer 1d6 points of Con damage; this stage lasts until he is reduced to 3 Con.
Third Stage: By this time, the victim is a shell of his former self, a shambling, zombie-like figure. He can't sleep at all, can barely concentrate on anything for more than a few minutes, can't maintain focus long enough to cast spells or manifest psionic powers, and eats and drinks very little. He jumps at shadows, and is startled by even the slightest noise – laughter that sounds even close to cackling is enough to send him into a cowering panic. Those who reach this stage seldom have long to live, as natural healing ceases to function – they take 1d6 points of Con damage per night until they die or are cured.
Cures: Slaying the night hag that bit the victim will immediately halt the disease’s spread, as will a remove curse followed by cure disease.
Special: Every time the victim fails a save, he must make another save, or 1 point of Con damage becomes permanent. If the victim dies, his soul is seized by the night hag that bit him and he can't be raised or resurrected unless it is freed.
Devil Chills
Devil chills is a fairly rare disease spread by the bite of barbazu (barbed devils) and pit fiends. It weakens the victim's musculature, inducing tremors.
Frequency: Rare
Severity: Moderate
Vector: Injury
DC: 14
Incubation Period: 1d4 days
Effects:
First Stage: The victim runs a low fever (100 in humans) and feels chilly – even sitting near a hot fire will not alleviate the shivers, which incur a -1 penalty to Dex-based skills and Reflex saves. This stage lasts for 1d2 days; the victim must make a Fort save each day or take 1d2 points of Strength damage.
Second Stage: The fever remains the same, but the shivers become more violent as the disease spreads through the victim's muscles. He suffers a -3 penalty to Dex-based skills and Reflex saves. A failed Fort save (made each day as before) incurs 1d4 points of Strength damage. This stage lasts until the victim's Strength is reduced to 3.
Third Stage: The victim's muscles are so weakened by this point that he can't walk without aid, and can barely hold even small, light items. He is often confined to either a bed or a comfortable chair and bundled in blankets (which don't help – the chill is supernatural, not normal).
Those who endure the disease this long and manage to recover suffer lingering aftereffects – for the next 1d4 months, they suffer a -4 penalty on checks involving muscular endurance, like running, swimming, or holding up a heavy object for a long period of time. Those whose Strength score is reduced to 0 suffer permanent damage (1d4 points of Strength drain).
Cures: Cure disease will work, but only after the wound has been purified, either with the application of a vial of holy water or a bless spell.
Special: —
Filth Fever
Filth fever is a fairly common disease among adventurers and others who delve into sewers and old dungeons, where it can be found in proliferation, or dungsweepers and those who deal with garbage. The disease is spread by the bite of dire rats, otyughs, and other creatures that inhabit sewers and garbage heaps.
Frequency: Common
Severity: Mild
Vector: Injury
DC: 12
Incubation Period: 1d3 days
Effects:
First Stage: Red lines spread from the wound as it becomes infected, and the wound itself is tender and slightly painful to the touch. This stage lasts for about 24 hours.
Second Stage: As the infection progresses, the wound becomes filled with pus, and the lines extend and turn greenish in color close to the wound. The victim exhibits a fever (100-102), and may become delirious. If left untreated, the wound itself, as well as a patch of skin around it, turns black as gangrene sets in over the course of the next 1d4+1 days. Each day, the victim must make a Fort save or take 1d3 points of Con damage.
Third Stage: Filth fever very rarely progresses to this stage – even basic healing can cure it before the wound turns gangrenous. If the wound remains untreated, though, the gangrene spreads up the affected limb and blood poisoning sets in. Short of removing the limb, only a heal spell will save the victim at this point. The victim lapses into a delirious fever and dies 1d3 days later.
Cures: A successful Heal check, along with application of a poultice or other healing herbs, will halt the spread of the disease and heal the wound in the first or second stages.
Special: —
Ghoul Fever (Corpse Fever, Ghoul Plague)
Ghoul fever, also called corpse fever or ghoul plague, is an infection caused by claw or bite wounds from ghouls and ghasts. Since these creatures feed on carrion, their claws are filthy with decomposing flesh, body fluids, and dried blood, and they can easily infect living beings with this mess. The disease is passed through a claw or bite wound into the bloodstream. From there, it spreads up the affected limb, causing blood poisoning, gangrene, and eventually, if not treated, death.
Frequency: Uncommon
Severity: Severe
Vector: Injury (claw)
DC: 15 (save every hour after the second stage)
Incubation Period: 3d8 hours
Effects:
First Stage: In the hours after the wound is inflicted, it appears red and slightly swollen, tender to the touch. Even if the wound is healed, the area will still exhibit redness and swelling. After 1d3 days or two failed Fort saves, whichever comes first, red lines start to spread from the wound, and it turns greenish-black as infection sets in and it turns gangrenous.
Second Stage: The victim falls into a delirium characterized by high fever, profuse sweating, and chills, and may pass into a coma. Unless the victim is cured or the limb is removed, the infection spreads and the victim loses 1d6 Con per day. Fort saves no longer apply at this stage, as widespread gangrene is impossible to recover from without magical treatment - a heal spell or better.
Third Stage: If the infection has not been treated by this point and the victim reaches 0 Con, he dies.
Cures: Cure disease will heal corpse fever before the wound goes gangrenous; after that, a heal is required to purge the infection. Anointing the wound with at least one flask holy water has a 50% chance of curing the disease on its own, but this will work only during the first stage.
Special: An afflicted humanoid who dies of ghoul fever rises as a ghoul at the next midnight. A humanoid who becomes a ghoul in this way retains none of the abilities it possessed in life. It is not under the control of any other ghouls, but it hungers for the flesh of the living and behaves like a normal ghoul in all respects. A humanoid of 4 Hit Dice or more rises as a ghast, not a ghoul.
Mummy Rot
Perhaps the best-known and most feared supernatural disease among adventurers, mummy rot is a form of advanced leprosy inflicted by the touch of a mummy. Unlike leprosy, however, it does not stop with the extremities, but progresses steadily until the victim’s entire body rots away, even after death (see below).
Frequency: Uncommon
Severity: Fatal
Vector: Contact
DC: 16 (initial check only - see below)
Incubation Period: 1 minute
Effects:
First Stage: A small necrotic patch of tissue appears at the area touched. The tissue is slightly numb to the touch and discolored, but has no other effects. This stage lasts for 1d3 days; the victim suffers 1 point each of Strength and Con damage per day.
Second Stage: The patch grows steadily over time, at the rate of about a half-inch per hour. The necrosis destroys the nerve endings and cuts off circulation to the affected area, turning the skin black and numb. If it reaches fingers, toes, or other extremities, the victim suffers appropriate penalties (hands/fingers: -4 to checks using the hands, and -2 to attack rolls using weapons; legs/feet: movement speed reduced, -2 to Reflex saves and Dex-related checks; ears: -4 to Listen checks). Minor extremities like fingers and toes that remain infected for more than one day spontaneously amputate (i.e., rot and fall off). The rate of Strength and Con loss is greater now - 1d6 each per day. This stage lasts until the victim’s Con is reduced to half its original score.
Third Stage: By this time the rot has usually gotten into the bloodstream, carrying it to all parts of the body; the victim has little chance of surviving. Hands and feet are usually infected and fall off, as well as the ears and nose; the victim is often blinded as the infection destroys the eyes. He has 1d3 days to live at this point, regardless of his Con score, as the rot gets to the major organs and starts to eat away at them.
Cures: The victim can make only one save to vs. mummy rot - the initial one to avoid infection. After that, the only way to cure this disease is by magical means. In addition, the victim’s wounds heal at 10% of the normal rate, and ability damage cannot be healed at all unless the disease is cured first. Since mummy rot is technically a curse, not a disease, it must first be broken with break enchantment or remove curse (either of which requires a DC 20 caster level check); after this, magical healing works normally, and the disease can be cured by cure disease.
Special: If a victim dies from mummy rot, the body decays into sand and dust that blows away with the first wind. Only a remove curse or break enchantment, followed by true resurrection, will bring the victim back.
Shakes (The Shakes, Tremors)
Shakes is a disease inflicted by the bite of the tarantella spider, a rare species found in tropical forests and jungles. It attacks the autonomous muscle control centers of the brain, causing the victim to lose control of his body. Victims often suffer from mild to severe tremors, fits of shaking, and - in extreme cases – seizures. While victims often recover from the shakes, they seldom do so without lasting effects, such as involuntary twitching when tired or under stress.
Frequency: Rare
Severity: Severe
Vector: Injury
DC: 13
Incubation Period: 1 day
Effects:
First Stage: The symptoms of the first stage of the shakes are very mild and are often ignored – when the victim is in a stressful situation (combat, in fear for his life, etc.), he suffers involuntary contractions to various muscle groups, incurring a -2 penalty to Dex checks, Dex-related skills, and Reflex saves. The contractions last for 1d4 minutes, or until the victim sits down to rest for a full minute, whichever comes first. The victim must make a Fort save each day or take 1d2 points of Dex damage; this stage lasts until the victim’s Dex score is reduced to half.
Second Stage: The muscle twitches are triggered by the slightest stress to the body (spellcasting, strenuous activity like running or climbing stairs, etc.), are more pronounced (-4 penalty), and last longer (2d4+2 minutes); the penalty lasts until the victim has had at least ten minutes of rest. He must also make a DC 10 Fort save during an episode of the tremors; if the save fails by 5 or less, the fit lasts longer than usual, and the character is exhausted afterward (half hour of rest required, and he suffers an additional -4 to all rolls until then). If the roll fails by 6 or more, the victim has a full-blown seizure – he falls to the ground and cannot take any actions until the fit passes. Even then, he suffers a -10 penalty to all rolls until he has a full hour of rest.
The deterioration is more rapid now; the victim must make a Fort save each day or take 1d4 points of Dex damage. This stage lasts until the victim is reduced to 3 Dex.
Third Stage: Nearly anything is enough to set off a fit of trembling; victims who reach this stage are in a constant state of mild tremors, interspersed with the rare seizure, and are almost always confined to bed. The victim continues to take 1d4 points of Dex per failed save until he recovers.
Cures: —
Special: This disease is rarely fatal, but those who are reduced to 0 Dex and recover are permanently crippled – paralysis is common, as well as recurring tremors and seizures as noted above; victims always suffer 1d4 points of Dex drain. A regenerate is necessary to cure paralysis; ability drain can be recovered only after a heal spell has been cast on the victim to heal damage inflicted by the disease.
Slimy Doom
A well-known ability of the aboleth is to inflict a strange disease on their slaves that causes the skin to turn into a clear mucous membrane that requires constant moistening or it will dry out. A less well-known ability held only by the savants is the infliction of slimy doom. This horrid affliction turns the insides to into infectious goo, and can cause permanent physical damage. This disease is also highly contagious - contact with an infected person or the infected liquid requires an immediate Fort save to avoid infection.
Frequency: Very rare
Severity: Fatal
Vector: Contact
DC: 18
Incubation Period: 1d4 hours
Effects:
First Stage: The victim has abdominal pain, cramps, and severe nausea; he has trouble keeping food down, and runs a low fever (100-102). This stage lasts for 1d3 days; a failed Fort save (1/day) incurs 1d2 points of Con damage.
Second Stage: As the disease progresses, the fever rises (103-105), and the victim can't keep anything solid down (and often vomits up any ingested liquids). This stage is often marked by bloody diarrhea and vomiting and trouble breathing as the victim's internal organs begin to break down. The victim must make a Fort save every 12 hours now; a failed save means 1d6 points of Con damage. This stage lasts until the victim's Con score is reduced to 3.
Third Stage: Those who make it to this stage seldom recover, as the damage is too widespread. The victim must make a Fort save every hour or lose 1 point of Con; at 1 Con, he goes into convulsions and falls into a coma, and death is almost always imminent at that point.
Cures: Only a heal spell or the touch of the aboleth that inflicted the disease can reverse its effects.
Special: Victims who die of slimy doom dissolve into puddles of infectious slime and cannot be resurrected by any means.
Each time the victim fails a Fort save, 1 point of Con damage becomes permanent.
