Disease List

Table 1: Normal Diseases
Disease Frequency Severity Vector DC Incubation
Black shakes Very rare Fatal Contact 20 1d8 days
Blinding sickness Common Moderate Ingested 15 1d3 days
Boneblight Rare Fatal Contact/Spell Var.1 1 hour
Bone scourge Rare Severe Contact 12 1d4 day
Burning plague Rare Fatal Unknown1 19 1 day
Cackle fever Uncommon Moderate Inhaled 17 1 day
Cold fever Uncommon Moderate Contact 15 1d4 days
Creeping doom Very rare Fatal Injury Var.1 Immediate
Crimson scourge Very rare Fatal Contact/Spell Var.1 Imm. or 1d4 hours1
Crypt lung Uncommon Severe Inhaled 15 1 day
Demon fever Rare Severe Injury 18 1d4 hours
Devil chills Rare Moderate Injury 16 1d4 days
Filth fever Common Mild Injury 12 1d3 days
Ghoul fever Uncommon Severe Injury 18 3d8 hours
Khefren's curse Rare Fatal Contact Var.1 Immediate
Mummy rot Uncommon Fatal Contact 22 1 minute
Red ache Common Moderate Injury 15 1d3 days
Shadow blight Rare Fatal Special2 15 2d6 hours
Shadow plague Very rare Fatal Contact, Injury 181 Immediate
Shakes Rare Mild Injury 13 1 day
Slimy doom Very rare Fatal Contact 25 1d4 hours
Zombie plague] Rare Fatal Special2 18 1d4 hours

1 See the individual entry for details.

2 Successful saves do not allow the character to recover from mummy rot; only magical healing can save him.

Black Shakes

Black shakes is caused by long-term exposure to negative energy, whether through spells, items, creatures, or the Negative Energy Plane itself. Rarely, those who suffer repeated energy/ability drain from undead (mostly undead hunters) catch it, but the most common victims are necromancers and those who research the undead or negative energy. It is, thankfully, not contagious, but those who die from it often turn into some form of undead.

Checks for infection should be made:

Once per week after a six-month periuod where the person was exposed to negative energy at least once per day for more than half the month (i.e., casting spells, being around undead, or using/creating magic items);

If the person loses more than 10 Hit Dice or 20 ability points to negative energy in a month's time;

Once per day after the first month the person is exposed to direct negative energy radiation (such as from an open portal to the Negative Energy Plane).

These checks should be made every time the conditions are met; even if the Fort save is successful, the DC increases by 1 each time until he spends an entire month free of negative energy exposure (to include level/ability drain or casting spells using negative energy); the person must also either be exposed to sunlight for an hour or more or receive a bless spell each day to counteract the negative energy build-up. For those who are already sick, these measures grant a +2 bonus to the Fort save to recover from the black shakes.

Frequency: Rare

Severity: Fatal

Vector: Contact

DC: 20

Incubation Period: 1d8 days

Effects: Among those who suffer from repeated exposure to negative energy, the symptoms of black shakes are often difficult to discern, which makes this affliction all the more deadly.

First Stage: The victim feels slightly run-down and may suffer mild joint ache and fever. He suffers a -2 penalty to all skills. This stage lasts for 1d4+1 days.

Second Stage: The disease's symptoms become more apparent as the negative energy spreads through the victim's body, turning his veins black. The spread typically starts from the head or the heart and spreads over the course of the next 1d4 days. The victim suffers a high fever during this time (103 in humans) and cannot undertake strenuous actions. A Fort save must be made each day; a success delays the disease's spread for 24 hours. When the transformation is complete, he enters the third and final stage.

Third Stage: Those who enter the third stage very rarely recover, and never without magical aid. The victim's skin turns gray and leathery, and he takes 1d3 points of Con drain per day until he dies.

Cures: Aside from the preventative cures noted above, bless followed by cure disease in the first stage will cure the black shakes; in the second stage, prayer and heal are required; in the third stage, nothing short of a lesser miracle or limited wish will work.

Special: Unless the body is blessed and/or burned, 24 hours after dying, the victim rises again as a juju zombie.


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.

Bone Scourge

In most cases, undead are immune to diseases - they don't need their internal organs to be functional, and they have little use for both muscles and nerves. Even highly virulent diseases cannot break the energy that animates them.

One of the few exceptions to this rule is bone scourge. This disease is incapable of harming anyone with an active immune system (read: living beings), but undead are vulnerable to it. Bone scourge is normally found on corpses dead at least a month; necromancers, evil clerics, and others who work with the dead and undead having been trying for centuries to eradicate it to no effect. No one is quite sure where it comes from, or who first created it (the general consensus is that it is either divine in origin or was dreamed up by a powerful undead hunter), but all undead fear it. Many undead hunters carry pouches of powdered bones from undead afflicted with this disease; if the bone dust is sprinkled over an undead, it must make a Fort save or become infected.

The disease attacks the undead's bones, weakening the structure (and hence the victim's strength). Since undead cannot be affected by cure disease and have no immune system to fight off the infection, bone scourge eventually weakens the bones to the point where the skeleton collapses under its own weight, rendering the undead effectively helpless.

Frequency: Rare

Severity: Severe

Vector: Contact

DC: 12

Incubation Period: 1 day

Effects:

First Stage: The victim suffers a -1 penalty to its Strength score as the bones are slightly weakened. This stage lasts for approximately 1d4 days.

Second Stage: The victim suffers an additional -2 penalty to Strength as the disease spreads and begins severely weakening the bones. The victim also suffers double damage from bludgeoning weapons and crushing attacks. This stage lasts for 2d4 days.

Third Stage: The victim suffers an additional -4 penalty to Strength as the bones are weakened to the breaking point. Visible bones are pitted and porous; if the victim engages in strenuous activity (combat, running, etc., but not spellcasting), it must make a DC 17 Fort save or break a bone related to that activity (leg bone for running, arm bone or other bone struck for combat, etc.). Also, any crushing or bludgeoning attack that deals more than 5 points of damage automatically breaks 1d4 bones. If the victim suffers a fall, it must make a Reflex save (DC 20, +2 per 10 feet fallen past the first 10) or suffer double damage and have 2d4 bones broken. This stage lasts for 2d4 days.

Fourth Stage: Most undead are unable to move by this point due to the sheer number of broken bones.
If not stopped, the disease continues to spread, reducing the Strength score by 1 point per day until the bones literally fall apart, reducing the undead to a helpless pile of rotten flesh and bone dust.

Cures: A harm spell will halt the spread of the disease, while the application of an energy drain will restore lost ability points at the rate of one per level the spell would normally drain.

Special:

Boneblight

Boneblight is an evil, deadly curse that erodes the bones of any chosen creature in range of the spell. If the victim fails a Fort save, its bones slowly begin to pit and corrode, eventually reducing it to a quivering mound of formless flesh. It is inflicted by the spell of the same name.

Frequency: Rare

Severity: Fatal

Vector: Contact (Spell)

DC: Special (spell DC)

Incubation Period: Immediate

Effects: See spell

Cures: Remove curse followed by heal, or a lesser miracle, limited wish, miracle, or wish will cure the affliction.

Special: This spell prevents natural healing. Magical healing slows, but cannot stop, the third stage. Every 10 points of magical healing prolongs the second stage for one full day, to the maximum of 1 day per point of the victim's (original) Con score.

Burning Plague

Burning plague is a mysterious disease that appears at random, runs a course, then vanishes, only to appear somewhere else days, months, or even years later. It is not exactly known how the plague came about, how it is spread, or why it suddenly appears and disappears. It is postulated that one being, or a group of them, go around spreading the plague, but evidence is very sketchy at best, and no one has claimed culpability. Certainly there are no known spells that cause this disease, so some sages have suggested that it is divine in origin, used to punish mortals for their transgressions. In any case, the effects of the burning plague are some of the more horrifying to behold. Often, more people are killed from the resulting fires than from the plague itself, but in any case, entire towns and villages have been quickly decimated by an outbreak of burning plague.

(For GM reference: The disease is an airborne virus that lives on the Ethereal Plane; it is brought over to the Prime by travellers, creatures that exist on both planes, like ghosts, or can spontaneously appear through weak spots in the planar barriers. It disappears rapidly because it has a short incubation time and often kills its victims before it can be spread very far.)

Severity: Fatal

Vector: Unknown (Inhaled)

DC: 19

Incubation Period: 1 day

Effects:

First Stage: Burning plague starts off as a normal low-grade fever (100-101); victims feel run-down, achy, and feverish, as with the flu or several other diseases. This typically lasts for 24-36 hours.

Second Stage: The fever increases drastically, reaching 105-106 degrees. The victim has about 2d4 hours to live when he reaches this stage; the skin becomes flushed, and he sweats profusely and becomes delirious with fever. If he does not make two successful consecutive saves (check every hour), he bursts into flame, taking 6d6 points of fire damage (which bypasses all resistance) per round until dead.

Cures: None known

Special: Victims of the burning plague burn completely to ash and cannot be raised or resurrected by any means short of a resurrection spell. Cure disease and divine health provide only a +15 or +5 bonus to saves respectively. Creatures native to the Ethereal Plane or that are immune to fire are also immune to burning plague, but granting fire immunity after infection does not prevent the victim from bursting into flames.

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:


Cold Fever

Cold fever is a slight misnomer – the disease is spread by spells that use elemental cold, but instead of suffering a fever, the victim's temperature drops. If untreated, he eventually dies of hypothermia. Fortunately, this disease, while uncommon, is fairly easy to treat. It is most commonly found among adventurers and mages who specialize in cold magics.

For game purposes, anyone exposed to magical or supernatural (damage-inflicting) cold for more than a full day, or who takes damage from magical cold spells at least once a day for a week, must make a check or fall prey to the disease.

Severity: Moderate

Vector: Contact

DC: 15

Incubation Period: 1d4 days

Effects:

First Stage: The victim complains of chills and often has shivering fits as his core body temperature drops 1d3 degrees. Despite outward appearance of fever, the victim's hands and feet are often cold and nail beds are blue due to reduced circulation.

Second Stage: The victim's core body temperature continues to drop 1 degree each time he fails a Fort save. At 95-90 degrees, the victim's movement rate is halved, most actions are difficult (-6 to all checks) due to lack of coordination, and spellcasting is impossible due to constant shivering and confusion (lack of blood getting to the brain due to poor circulation).

Third Stage: If the victim's core temperature drops below 90 degrees, he suffers a near-inability to speak or think clearly, and use of the hands is very difficult. He continues to grow colder, but at a faster rate – 1 save every hour.

At 86 degrees, the muscular coordination is nearly gone – walking is almost impossible – and the victim, if he's still conscious, exhibits irrational behavior or may drop into a stupor. At this point, he has 1d4 hours to live before organs start to fail and death occurs.

Cures: Keeping the victim warm (wrapping in blankets, keeping a fire nearby, putting him in a warm bath) grants a +4 resistance bonus to the Fort save to avoid temperature decrease; cure disease will also cure the victim immediately, though he recovers at the rate of 1d2 hours per degree.

Special: Creatures immune to cold cannot contract cold fever.


Creeping Doom

Creeping doom is a horrid rotting disease inflicted by arrikhan, a rare breed of vampire that can rot and reform themselves; they can inflict this same rotting disease on another with their bite if they so wish. It is one of the few diseases known to affect undead as well as living beings, though it has no effect on skeletal undead.

Frequency: Very rare

Severity: Fatal

Vector: Injury (bite)

DC: 18 (Check: varies; see below)

Incubation Period: Immediate

Effects:

First Stage: Once bitten, the victim is immediately infected. The area around the bite turns red, and lines begin to radiate out as the disease spreads. The flesh quickly turns greenish-black as it suppurates and gangrene sets in. The advance of the illness and the frequency of the saving throw against it is dependent on the arrikhan's age; very young (100 years old) arrikhans' rotting disease spreads fairly slowly (over the course of 1-2 weeks, requiring a check every day as normal), while an older (500 years) arrikhan's disease spreads in a matter of 1d4+1days, and a very old (over 1000) arrikhan's disease can kill a victim in 1d4 hours (requiring a check every hour). Each failed Fort save means the victim takes 1d4 points of Strength and Con drain.

Second Stage: As the disease spreads, the victim weakens and exhibits fever, chills, muscle aches, and loss of use of the afflicted limb(s).

Third Stage: Once the rot reaches the major organs or the head, the victim falls into a coma as his organs start to fail, and he usually dies very quickly after that (anywhere from 1-2 days for very young vampires to 30-60 minutes for ancient vampires, depending). This is one of the few diseases (except those created by gods) that can harm undead. Undead do not fall into a coma or suffer from organ failure, but once the rot reaches the brain, intelligent undead will die. Zombies whose Strength scores are reduced to 0 simply collapse into a pile of rotting flesh.

Cures: Holy water (or unholy, for undead) applied directly to the wound has a small chance (25%) of healing the disease, though it inflicts 1d6 points of burn damage to the victim; the disease can also be counteracted by the will of the arrikhan who caused it, or its master, if it has one.

Special: If the arrikhan is under 500 years old, a simple cure disease will halt the spread of the creeping doom, and the victim will make a full recovery over the course of the next 24 hours, though recovery of lost ability score points is as normal. If the arrikhan is up to 750 years old, a heal spell is necessary; up to 1000 years old, only a heal spell cast by a 15th level cleric will work; over 1000, a heal cast by a 20th level cleric is required. A wish or miracle will also work for creeping doom inflicted by arrikhan of any age.

Creatures who die as a result of creeping doom rot completely in 1d4 minutes and cannot be brought back by any means short of a true resurrection.

Crimson Scourge (Red Death)

This terrible bleeding curse, which often goes by the name "red death," is inflicted by the spell of the same name. Unlike other magical diseases, though, it is also extremely contagious. It is widely feared, even among blood mages, because of its contagious properties. Despite several attempts to destroy all knowledge of the spell's existence, it keeps making a reappearance.

Frequency: Very rare

Severity: Fatal

Vector: Contact (Spell)

DC: 17

Incubation Period: Immediate for those affected by the spell; 1d4 hours for anyone infected by a carrier.

Effects: Crimson scourge attacks the victim's blood, destroying platelets to prevent clotting, then weakening arterial walls and capillaries, which results in increased bruising and internal hemorrhaging.

First Stage: Victims of the crimson scourge feel a slight headache, and may have a nosebleed. They quickly (within 1 day) exhibit fever, chills, and aching joints. Open wounds bleed more profusely than normal (all piercing or slashing attacks are treated as wounding effects - the victim continues to lose 1 hit point/round until the wound is bound or healed). The victim is contagious at this stage – anyone coming into contact with his blood must make a Fort save or become infected also. This stage lasts for 1-2 days; a failed Fort save (made each day) means the victim takes 1d2 points of Con damage.

Second Stage: The victim suffers frequent and acute nosebleeds and may even weep bloody tears as the veins and capillaries weaken. Even the slightest contact results in painful bruising, and any wound causes profuse bleeding (2 hit points per round instead of 1). The victim must make a Fort save each day as before; a failed save means he takes 1d4 points of Con damage. Additionally, if he fails a save, he must make a second save or have 1 point of Con damage become permanent. This stage lasts until the victim's Con score is reduced to 3.

Third Stage: Those who survive to this stage suffer from massive internal hemorrhaging and start vomiting blood, as well as bleeding from the eyes, ears, nose, and mouth. They lose 1 Con point an hour (no save) until they die either from massive blood loss or drowning in their own blood.

Cures: Remove curse followed by heal. Cure disease will not work at any stage.

Special: Anyone who dies of the crimson scourge rises the next night as a red death zombie unless the body is burned. Any being that comes into physical contact with an infected individual or his blood must make a Fort save at the original DC or become infected himself.

Crypt Lung (Black Lung, Tomb Fever)

Crypt lung, also called black lung or tomb fever, is an affliction common among adventurers, tomb robbers, and archaeologists. It is caught by inhaling the dead, dry air of a long-closed tomb (at least 500 years old), or inhaling powdered bone dust from an old corpse (at least 100 years old), often from opening coffins or sepulchers without taking proper precautions (like wearing a mask over the nose/mouth).

Crypt lung starts out like a cold or mild case of the flu, which leads many victims to ignore its effects, but after it moves to the lungs, it can cause severe damage. Fortunately, it is not often fatal, and victims often recover with little or no aftereffect. This disease is mildly contagious – the Fort save for exposure to a victim is only DC 11, but again, those wearing a face mask are protected.

Frequency: Uncommon

Severity: Severe

Vector: Inhaled

DC: 15

Incubation Period: 1 day

Effects:

First Stage: The victim has a mild fever (99-100), possibly accompanied by runny nose, congestion, and a mild cough. This stage lasts for 1d3 days.

Second Stage: The fever worsens (101-103), as does the cough as the infection moves down into the chest. Victims have a hard time speaking due to a raw throat (spells with verbal components suffer a 50% failure chance), and even mild exertion causes a coughing fit. The victim must make a Fort save each day or take 1d2 points of Con damage; this stage lasts until the victim is reduced to Con 3.

Third Stage: Only those with weak immune systems, or those who are very unlucky, reach this stage – most others recover before then. The fever and coughing continue, but the victim begins bringing up blackish phlegm (hence the name black lung) as the infection eats into the tissues of the lungs. He continues to take 1 point of Con damage per day until dead or he recovers. Even if the victim recovers after reaching this stage, he suffers a lingering cough (see below).

Cures:

Special: If the victim's Con is reduced to 3 or below and he recovers, he retains a racking cough for the next 2d4 months, which shows itself after exertion – basically, anything that requires an Con check, including combat that lasts for more than 1 minute. The victim must make a DC 15 Fort save or suffer a coughing fit lasting 1d6 rounds, during which he can't take any actions; he suffers a -2 Con penalty lasting 1d2 hours afterward (this is cumulative, if the victim suffers multiple coughing fits). A regenerate or heal spell will cure the damage to the lungs.


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 of 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.


Khefren's Curse (Magebane, Mummy's Curse)

This disease is generally attributed to the mage Khefren, and is also called "magebane," or "the mummy's curse." Khefren was a powerful elven sorcerer who lived millenia ago. He was tired of all the challenges to his power, so he developed a nasty curse that affects only mages. Unfortunately, he fell victim to his own disease and accidentally killed himself during a spell duel with another mage. His tower was later ransacked, and the notes on the spell and several others were taken by unknown parties. It has since made its way to other planes, but it still remains extremely rare, fortunately. Most mages destroy any copies they find once they realize that this disease does, but some few evil-minded types have copies of it. Another side-effect of the spell was later discovered - it affects all spellcasters, both arcane and divine, though divine spellcasters' symptoms aren't as pronounced. Non-spellcasters are immune to Khefren's curse.

Frequency: Very rare

Severity: Fatal (see below)

Vector: Touch (spell)

DC: Variable (spell DC)

Incubation Period: Immediate (see below)

Effects: There are no symptoms, as such, for this disease - the victim doesn't know he's infected unless he has a detect disease spell cast on him or he tries to cast a spell. When he casts any spell (including casting spells from scrolls, but not using spell-like abilities or magical items), he must make a Fort save vs. DC 15 + spell level (DC 11 + spell level for divine spellcasters). If he fails, a small patch appears on his body somewhere. This patch is necrotic tissue, one of the first indicators of Khefren's curse.

If left alone, the patch will not spread, but it will not go away either. The size of the patch varies according to the level of the spell: 0- and 1st-level spells create a patch roughly 1/2 inch in diameter, and the size goes up 1/2 inch per spell level. Parts of the body were patches meet and grow together will start to rot and eventually, if not treated (see below), parts of the caster's body will spontaneously amputate (i.e., fall off).

No caster has lived past the point where over 50% of the body is rotted; most die long before that from complications (e.g., massive organ failure, gangrene, blood poisoning, or heart attack/stroke). As with mummy rot, this ability damage does not heal unless and until the disease itself is healed, except as noted below. Unlike mummy rot, however, Khefren's curse stops when the victim dies. Cure disease must still be cast before the body is raised, however.

Since the rate of spread is totally dependent on the amount of magic the victim uses, there is no set time frame for this disease. A spellcaster could live for years by not casting spells of any sort; this disease only becomes active when magic flows through the victim's body.

Cures: None

Special: Khefren's curse is permanent, barring magical cures - remove curse cast by a cleric of higher level than the mage who inflicted the disease, followed by either cure disease or heal, will cure it. Heal will reverse some of the disease's spread, while regenerate will reverse all of it, but neither spell alone will totally cure the victim.

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 Perception 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.


Shadow Blight

This slow and insidious disease affects only those living things that have overdosed on essence of shadow.

Frequency: Rare

Vector: Special

DC: 15

Incubation Period: 2d6 hours

Effects:

First Stage: The victim experience numbness and tingling in the extremities and suffers from light sensitivity; he gains a bruised-looking appearance on a random part of his body. The bruising spreads over 11-20% of the remaining body each day unless the victim endures the intense physical pain (1d6 hit points of nonlethal damage per hour) of exposure to direct sunlight. This grants him a new saving throw (DC 17) if he is exposed for at least 5 hours each day. Once the bruising completely covers the skin, exposure to sunlight deals lethal (fire) damage, and the DC increases to 22.

Second Stage: Once the bruising has completely covered the victim's skin, he suffers extreme light sensitivity (-2 to all rolls) and, as noted before, suffers 1d6 points of fire damage per hour from exposure to direct sunlight. He also suffers a -2 penalty to saves against light-based spells and takes +1 point per die of damage, if applicable. The victim typically suffers a low fever (99-101 degrees in humans), and loses most of the feeling in his limbs as the nerve endings are destroyed. This stage lasts for 1d4 days.

Third Stage: Victims who progress to this stage usually fall into a coma. Those who don't suffer from extreme nausea, to the point where they are incapable of keeping anything down - anything he eats or drinks is vomited back up within 1d4 minutes, leaving him feeling shaken and weak (he is considered nauseated). Starvation inevitably sets in, and the victim wastes away to nothing.

Cures: If the victim drinks at least a pint of holy water in a day, or exposes himself to direct sunlight for 5 hours a day, he gains a new Fort save (DC 17). Cure disease will not cure shadow blight, but a heal spell will.

Special: If the victim dies, his body rapidly (within an hour) decays into blackish ash, and he rises as an undead shadow 1d4 hours later. Blessing the ashes or dousing them with holy water before the victim rises keeps him from rising as an undead.


Shadow Plague

This rare affliction is sometimes granted to high priests of evil gods and is sometimes inflicted on victims by gods of shadow as a divine curse. Some few creatures of shadow also have the ability to inflict it with their bite. This disease is much feared, as those who die from it waste away and become undead shadows, forever beyond help or hope of resurrection.

Frequency: Very rare

Severity: Fatal

Vector: Touch, injury

DC: 18 (no save for divine curse)

Incubation Period: Immediate or 1d4 hours

Effects:

First Stage: If the victim fails his initial save, a small gray-black blot appears at the point of contact (whether touch or bite). This blot is slightly numb and does not otherwise exhibit any unusual features, but it quickly spreads over the next 1d4 weeks. The victim will exhibit an increasing aversion to bright light, but is not otherwise adversely affected. Fort saves are made every week, but the victim does not take any damage at this stage.

Second Stage: This stage occurs when the blackness reaches the victim's face. He gains the Light Vulnerability special quality, and gains low-light vision, but his eyes turn grayish (irises and corneas). The victim must make a Fort save every day or take 1 point of Con damage. The shadow spreads with each failed save until it covers half the body and the victim is at half his original Con score.

Third Stage: The victim becomes more susceptible to light-based attacks; such attacks deal +1 point per die of damage, and the victim gains a -1 circumstance penalty on saves. The disease also progresses more rapidly now. The victim takes 2 points of Con damage per failed save until he reaches 25% of his original total (round up). The shadow spreads with each failed save until it covers 75% of the body, and the disease enters the fourth stage.

Fourth Stage: The victim develops a high fever (103+ in humans) and falls into a coma. He then loses Con points at the rate of 1 per hour (no save) until he is either cured or dies.

Cures: Cure disease cast by a cleric at least 2 levels higher than the cleric or creature who inflicted it will halt the spread of the plague, but will not cure it. Remove curse followed by cure disease or heal will cure the shadow plague (provided the cleric's caster level is 2 or more higher, as noted above), as will the touch of the cleric or creature that inflicted it, if he so wills it. If the disease is inflicted by a god as a divine curse, nothing short of that god's will will reverse it.

Special: Once the advance is complete (Con score reduced to 0), the victim dies, his flesh dissolves away within 1d4 minutes - eaten by the shadow sickness - and he becomes a full-fledged shadow, with all the abilities thereof. Once this has occurred, the victim cannot be brought back short of divine intervention.


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 short of a resurrection.

Each time the victim fails a Fort save, 1 point of Con damage becomes permanent.


Zombie Plague

Zombie plague is caused by the accumulation of large quantities of necromantic magics. If over 100 spell levels of necromantic spells (or spells that use negative energy) are cast at the same location within a 24-hour period, there is a 25% chance that the area will accumulate enough energy to spawn zombie plague. For each spell level above 100, the chance increases by 1%. Anyone spending time in such an area has a 20% chance per hour of inhaling tainted dust or plant spores; anyone drinking water or eating food grown in the area must make an immediate Fort save or become infected.

Some necromancers deliberately cast spells in an area in an attempt to create zombie plague, in order to raise zombie armies with a minimum of fuss while simultaneously clearing entire villages of people. The disease creates flesh-eating zombies, which feed on living beings, spreading the disease with their bites (treat these zombies as ghouls with no Int score).

Frequency: Very rare

Severity: Fatal

Vector: Inhaled/Ingested/Injury

DC: 18

Incubation Period: 1d4 hours

Effects:

First Stage: Zombie plague spreads quickly through living tissue; a few hours after failing the first Fort save, the victim begins running a low fever (99 in humans) and has achy joints. This stage lasts for 24 hours.

Second Stage: The fever rises to 100-101 degrees, and the victim suffers 1d4 points of Con damage per failed check (check once a day). Engaging in strenuous activity for more than 10 minutes at a time results in the victim becoming fatigued until he rests for an hour. This stage lasts for 1d3 days.

Third Stage: Anyone not healed by this point is pretty well doomed, as he cannot recover by natural means. The victim's skin takes on a grayish pallor, and he continues to lose 1 Con point per hour until he dies.

Cures: Cure disease will work in the early stages, though the wound must be cleansed with holy water; after the initial stage, a heal spell is necessary. Once the victim has reached the third stage, only a lesser miracle or limited wish can cure the disease.

Special: Those who die from zombie plague have a chance to rise as undead 1d6 hours later, unless the bodies are blessed and/or burned. Roll 1d10 and consult the table below:


Roll Effect
1-4 Victim doesn't animate
5-8 Victim animates as a plague zombie
9-10 Victim animates as a ghoul

Plague zombies are free-willed undead; if they receive no orders from a cleric who can control them, they immediately seek out living beings to consume (treat them as normal zombies with a bite attack that deals damage according to their size - 1d2 for Small creatures, 1d3 for Medium, or 1d4 for Large; a bite requires a DC 18 Fort save or the victim becomes infected).

Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.0 License