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Diseases

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    A plague ravages the kingdom, setting the adventurers on a quest to find a cure. An adventurer emerges from an ancient tomb, unopened for centuries, and soon finds herself suffering from a wasting illness. A warlock offends some dark power and contracts a strange affliction that spreads whenever he casts spells.

    A simple outbreak might amount to little more than a small drain on party resources, curable by a casting of lesser restoration. A more complicated outbreak can form the basis of one or more adventures as characters search for a cure, stop the spread of the disease, and deal with the consequences.

    A disease that does more than infect a few party members is primarily a plot device. The rules help describe the effects of the disease and how it can be cured, but the specifics of how a disease works aren’t bound by a common set of rules. Diseases can affect any creature, and a given illness might or might not pass from one race or kind of creature to another. A plague might affect only constructs or undead, or sweep through a halfling neighborhood but leave other races untouched. What matters is the story you want to tell.

    Contents

    Sample Diseases

    The diseases here illustrate the variety of ways disease can work in the game. Feel free to alter the saving throw DCs, incubation times, symptoms, and other characteristics of these diseases to suit your campaign.

    Ashen Inflammation

    Source 5e Horror (FGG)

    This disease is a mounting fever that eventually consumes its victims in fire. Those coming into contact with infected individuals, or the ash of the immolated victims must make a DC 13 Constitution saving throw or become infected. Creatures that do not breath receive advantage on this saving throw.

    The first symptoms of the disease appear in 1d4 + 1 hours, as the infected begin to develop a heavy fever and rash. The infected creature suffers 1 level of exhaustion; while the infected creature has at least 1 level of exhaustion they are also vulnerable to cold damage. At the end of each long rest, the infected creature must make a DC 15 Constitution saving throw. On a failure, they take 2 (1d4) fire damage for each level of exhaustion they possess and gain another level of exhaustion. On a success, they take no damage and lose a level of exhaustion. If the creature reaches level 6 of exhaustion, they burst into bright flame and then become a pile of loose ash. All creatures within 10 feet of the dying creature must make a DC 14 Dexterity saving throw or take 27 (5d10) fire damage on a failed save, or half as much damage on a successful one. Once the infected creature loses all levels of exhaustion, the disease ends.

    Blood Fever

    Source Vigil Watch Chapter One: The Toe Islands © 2020 Onyx Path Publishing

    Anyone consuming food or water contaminated by titan’s blood must make a DC 14 Constitution saving throw or suffer the effects of the ailment known as blood fever. Blood fever’s incubation period is 24 hours. When the incubation is complete, the victim reduces their hit point maximum by 5 (1d10), becomes poisoned until the disease is cured, and begins to convulse, literally sweating blood. The victim also hallucinates disturbing visions of violence and death. Every 24 hours that elapse, the infected must repeat the Constitution saving throw, reducing their hit point maximum by 5 (1d10) on a failure.

    This reduction to the creature’s hit point maximum lasts until the disease is cured. The disease is cured on a success. The victim dies if the disease reduces their hit point maximum to 0. A character that dies in this way rises as a blood fever zombie one day after death.

    Anyone who comes into physical contact with a victim of blood fever risks catching the disease as well, though the Constitution saving throw against contracting blood fever in this manner is DC 10. If a character makes a successful save, they are immune to contracting blood fever for 48 hours.

    Blood fever can be cured by a lesser restoration spell and other similar effects.

    Bloodmold

    Source 5e Horror (FGG)

    Wounds infected by poisonous spores wafting through the air of the jungle can carry dangerous toxins through the bloodstream, making it difficult to heal from injuries. When a creature is reduced to less than half of its hit points while inside of the jungle during the night, it must succeed on a DC 13 Constitution saving throw or become infected. It takes 2d4 hours for bloodmold’s symptoms to manifest in an infected creature. Symptoms include lightheadedness and disorientation. The infected creature only restores half as many hit points as normal from magical healing, when spending hit dice during a short rest, or after taking a long rest. At the end of each long rest, an infected creature must make a DC 13 Constitution saving throw. After 2 successful saving throws, the creature recovers from the disease.

    Bubonic Plague

    Source FGG:RA

    The first time a creature approaches within 5 ft. of a creature carrying the bubonic plague, and every hour in proximity thereafter, it must succeed on a DC 15 Constitution saving throw. Onset is after 1d4 days, after which the victim becomes contagious. The victim loses 1d4 points of constitution and 1 point of charisma per day thereafter; they may attempt a DC 15 Constitution saving throw each day to avoid the ability damage; two successful saving throws in a row defeats the disease. If the victim is still alive after 5 failed saving throws, they become incapacitated from cramps and pain. Once the victim is no longer ill, the ability loss heals normally at one point of each ability after every long rest.

    Bubbling Fever

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    The result of exposure to one infected with the Bubbling Pox. The infectious sores are far less pronounced on such a humanoid, but the effect on their bodies is devastating. Sweating, coughing, and retching over a period of days or weeks – the fever is harsh and agonizing.

    A debilitating condition, and quick to spread to those near the infected. A town with a single case of either the Pox or Fever might need to shutter their gates for weeks or months for their healers to get control of the outbreak, crippling the populace as they become infected and reinfected. Due to diligent efforts to control the Bubbling Pox that causes this disease, outbreaks are rare, but academics know that it would take but one case to create a catastrophe – or one cell of a plague cult to bring an outbreak to bear. Spread of the Bubbling Fever occurs through physical exposure to someone already infected with the Bubbling Fever or Bubbling Pox.

    Those exposed must succeed on a DC 10 Constitution saving throw or also become infected with the disease, with symptoms manifesting within a week. An infected humanoid instantly gains one level of Exhaustion and takes 1d4 damage each day thereafter and must succeed on a DC 10 Constitution saving throw or gain one level of Exhaustion. Additionally, they do not recover hit points or hit dice following long rests while infected. On a successful save, the infected character’s exhaustion level decreases by one level.

    If a successful saving throw reduces the infected creature’s level of exhaustion below 1, the creature recovers from the disease. However, no resistance or immunity is conferred and they can be immediately reinfected if exposed to the Fever once more. A half cup of honey directly consumed suppresses the disease for a day, preventing accumulation of Exhaustion on that day’s save should it be failed.

    This fact has made more than one apiarist either wealthy indeed or mobbed by desperate crowds during particularly devastating outbreaks, to the point that legends tell of honey being sold for its weight in gold in some places, with mixed results.

    Bubbling Pox

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A favorite of plague worshippers and creatures of filth, the Bubbling Pox turns its humanoid victims into unwilling tools in their war against the clean and living. The sores that cover the infected’s body bubble and pop at random, spreading contagion wherever the unlucky soul travels. In a sick irony, the Pox works to suppress other diseases yet to manifest in the infected, instead working to preserve such infections without harming the host, making them an unwilling carrier. Those so infected must be quickly treated or immediately ostracized – too often, the latter becomes a necessity in far off places unable to rapidly procure 4 the right assistance to treat the afflicted.

    There are rumors of colonies of people so banished, gestation chambers for yet undiscovered plagues and poxes. Spread of the Bubbling Pox occurs through physical exposure to someone so infected or from certain plague rituals – at least one cult is known to willingly infect themselves before entering urban areas. Those exposed must succeed on a DC 10 Constitution saving throw or also become infected with the disease, with symptoms manifesting within a week. Other than relatively painful blisters and sores across the body, infected humanoids suffer no ill effects personally.

    However, they carry in their sores and lungs the Bubbling Fever (and potentially other diseases). Those around them must regularly (once per day, after direct contact with the infected, or on another routine relevant for another disease) make tests to resist Bubbling Fever or another disease that infected person carries. The Bubbling Pox lasts indefinitely unless magically cured.

    Cackle Fever

    Source FGG:RA

    This disease targets humanoids, although gnomes are strangely immune. While in the grips of this disease, victims frequently succumb to fits of mad laughter, giving the disease its common name and its morbid nickname: “the shrieks.”

    Symptoms manifest 1d4 hours after infection and include fever and disorientation. The infected creature gains one level of exhaustion that can’t be removed until the disease is cured.

    Any event that causes the infected creature great stress—including entering combat, taking damage, experiencing fear, or having a nightmare—forces the creature to make a DC 13 Constitution saving throw. On a failed save, the creature takes 5 (1d10) psychic damage and becomes incapacitated with mad laughter for 1 minute. The creature can repeat the saving throw at the end of each of its turns, ending the mad laughter and the incapacitated condition on a success.

    Any humanoid creature that starts its turn within 10 feet of an infected creature in the throes of mad laughter must succeed on a DC 10 Constitution saving throw or also become infected with the disease. Once a creature succeeds on this save, it is immune to the mad laughter of that particular infected creature for 24 hours.

    At the end of each long rest, an infected creature can make a DC 13 Constitution saving throw. On a successful save, the DC for this save and for the save to avoid an attack of mad laughter drops by 1d6.

    When the saving throw DC drops to 0, the creature recovers from the disease. A creature that fails three of these saving throws gains a randomly determined form of indefinite madness.

    Cackle Fever

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    This disease targets humanoids, although gnomes are strangely immune.

    While in the grips of this disease, victims frequently succumb to fits of mad laughter, giving the disease its common name and its morbid nickname: “the shrieks.” Symptoms manifest 1d4 hours after infection and include fever and disorientation. The infected creature gains one level of exhaustion that can’t be removed until the disease is cured. Any event that causes the infected creature great stress—including entering combat, taking damage, experiencing fear, or having a nightmare—forces the creature to make a DC 13 Constitution saving throw.

    On a failed save, the creature takes 5 (1d10) psychic damage and becomes incapacitated with mad laughter for 1 minute. The creature can repeat the saving throw at the end of each of its turns, ending the mad laughter and the incapacitated condition on a success. Any humanoid creature that starts its turn within 10 feet of an infected creature in the throes of mad laughter must succeed on a DC 10 Constitution saving throw or also become infected with the disease.

    Once a creature succeeds on this save, it is immune to the mad laughter of that particular infected creature for 24 hours. At the end of each long rest, an infected creature can make a DC 13 Constitution saving throw. On a successful save, the DC for this save and for the save to avoid an attack of mad laughter drops by 1d6.

    When the saving throw DC drops to 0, the creature recovers from the disease. A creature that fails three of these saving throws gains a randomly determined form of indefinite madness, as described later in this chapter.

    Calcification Virus

    Source 5e Horror (FGG)

    This virus slowly turns the victim’s bodily fluids into a solid calcified substance. Sufferers typically suffocate on their own blood well before their blood completely calcifies. As the body decomposes, fluids calcify as well, until the body turns into bones and dust.

    The dust carries the disease and can become infectious if breathed in or ingested. Creatures exposed to the disease must make a DC 14 Constitution saving throw or become infected.

    Within a day, the victim begins to feel pain and fatigue. After 3 days, the creature begins to develop rough patches over the skin that feel hard and thick.

    At this stage, the creature has disadvantage on Constitution checks (but not saving throw). After 8 days, the creatures become blind and develops stiff joints, gaining disadvantage on Dexterity checks, as well as reducing their movement speed by half.

    After 18 days the infected creature must make a DC 12 Constitution saving throw every hour or begin to suffocate. There is no cure for the crystal virus.

    Creatures suffering from the disease remain infected until the disease is cured with magic or they die.

    Curiously, if an infected creature has their shape changed, they may attempt another save to end the disease when they return to their original form.

    Celestial Melancholia

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Said to be caused by exposure to stardust cast down by ancient and malevolent beings among the stars, this particular brand of Melancholia is a brutal one, of the utmost torture for the afflicted. It begins with mere bad dreams of unpleasant situations, but this is followed shortly by true and horrific nightmares filled with visages of deeds and beings beyond adequate description by the afflicted once they wake.

    Nightly they are visited by such sights, which become more and more oppressive with each passing slumber. Eventually, the afflicted begin to describe the horrors not as something from a dream, but something present with them, watching them through their very minds – this accompanied by other delusions. As the disease progresses, the visions do not stop with sleep, following the victim into their waking hours as well, where they will describe a perpetual paranoia of being watched from afar, and indeed from the very sky and stars above.

    Eventually this mania consumes them and their 5 very will to live. The worst cases see the afflicted enter a permanent fugue state. It is never quite clear the vector of infection for this Melancholia is, nor exactly when the infected must be exposed for symptoms to manifest.

    What is known is that symptoms begin to manifest among the population of certain, discrete locations at seemingly random times. These areas can be a single household or an entire town, and those within must succeed at a DC 15 Willpower save or soon begin experiencing symptoms. An infected humanoid or creature must make a DC 10 Willpower save every time they sleep or take a long rest, or else succumb to the nightmares.

    If they succumb, they lose 1 Willpower which can only be recovered by ordinary means after the disease subsides, recovering 1 Willpower each day until the maximum is reached. These nightmares persist nightly for 1d6 weeks before suddenly stopping. This disease cannot be removed by ordinary means before the period has lapsed, though spells such as Lesser Restoration and Lay On Hands or other effects that cure diseases may suppress symptoms for a day whenever applied.

    Choleric Worm

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Spread through filthy water, the eggs of this 6-or-soinch worm are hardy enough to weather the harshness of a humanoid’s stomach, though goblinoids are notably immune to its ill-effects (but not infection). Once in the intestine, they hatch and the newborn wretched creatures make their way elsewhere in the body- they are not particularly picky as to where. Once comfortable, they encyst themselves there, perhaps causing some mild discomfort, itching, and the occasional jolt of pain as they feed off their host’s body.

    They are not greedy worms- in truth, they take very little from the host, precisely enough to develop and reach maturity. The true harm of the worm is an unintended one: in order to survive a host body’s persistent efforts to oust the worm, it must suppress the host’s ability to fend off other infections of all sortsa potentially fatal problem for folk routinely exposed to dangerous illnesses. After a few weeks of developing within the host, the worm will work its way near the surface of the skin, creating an itchy, swollen sore which is soothed only by submersion in water.

    Once submerged, the worm will emerge and trouble its host no more, living in the water for a time before laying its eggs to start the cycle anew. On exposure to food or water contaminated with the worm, a humanoid must pass a DC 15 Constitution save or become infected. While infected, any saves to resist infection by or the effects of poisons or diseases must be made with Disadvantage.

    This effect lasts 1d6 weeks. The condition will resolve itself once the parasite departs, but it can also be removed via surgical incision and a DC 15 Medicine Skill Check.

    Clod’s Lock

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Flesh, when wounded, mends again to flesh, and bone, when broken, mends again with bone – or so it should be.

    Not everyone is so fortunate. An extremely rare disease, an unfortunate few are cursed to have their wounds fill in not with revitalized, if scarred, flesh, but with bone itself, filling cuts, sores, and even muscle torn from wear with solid and painful bone. While this begins as a discomfort and inconvenience, in time or with severe injury it becomes much more.

    Bone fills joints, fills the spaces between organs, everywhere if left unchecked, resulting in greatly impaired movement, pain at any jostle of one’s insides. Only careful, agonizing, and dangerous removal of the bony growths can keep the progression of the Lock at bay.

    The alternative is either an eventual grisly demise as one’s insides are replaced by cancerous bone growth, or complete immobility of the afflicted, trapped fully aware in a body fully capable of feeling the pain of its ongoing transformation. The Lock has its origins with a curse cast upon a cruel and wretched king in a bygone ancient land, thereafter spread by inhalation of dust from the bones of the king and those later exposed.

    Such exposure remains its primary vector of spread, especially among graverobbing adventurers who know not the history of the tombs they raid. A humanoid so exposed must succeed at a DC 13 Willpower save or be cursed. Someone so cursed must make a Constitution save any time they recover hitpoints.

    On a fail, half the HP they should have recovered is removed from their maximum hitpoints until the curse is lifted, or by exchanging 1 Agility to reset their HP maximum. Such reduced Agility points are lost until the curse is lifted or restored by surgery as below. Only be lifting the curse, whatever means that may be, can these effects be permanently resolved.

    Surgery through a DC 20 Medicine Skill Check can restore 1 Agility to the Character, though failure further reduces Agility by 1.

    Corvid Plague

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A vile plague spread through infected corvids – crows, jackdaws, bluejays, and their ilk. Those afflicted experience high fevers, violent coughs, fluid-filled lungs, discoloration of the face and chest, and extreme fatigue.

    The Plague causes a variety of potentially deadly bodily responses, most of which can be mitigated with common remedies and treatments if given proper attention, but too often such aid is unavailable or inadequate to stave off the symptoms. Birds carrying the disease are easily spotted – their 6 plumage and behavior is obviously that of a sick bird, but some places are so fearful of the Corvid Plague that they resort to wholesale slaughter of such birds upon sighting. For what it may be worth, this preventative treatment works, and the birds tend to stay away (healthy or not) after purges, whatever external consequences that may bring to the local environment.

    Survivors of this Plague are often rewarded with a lifetime cough from the internal damage it caused – better than death, but there are tragically comical tales of remote villages that survived an outbreak being quite noisy places to visit, with an ever-present cacophony of hacking and wheezing. A humanoid or bird exposed to an infected creature, such as by proximity, must succeed in a DC 15 Constitution save or also be infected. A creature so infected must succeed in a DC 20 Constitution save each day or take (Character Level+1)d6 of damage as the disease ravages their body.

    Kenku take double damage. During this time, an infected creature cannot recover hitpoints through natural means. The disease fades after 1d6 days, though creatures remain infectious for 1d6 days after that.

    Diligent care by another through a DC 15 Medicine skill check can suppress all symptoms for a day, but such a check can only eb attempted once per day.

    Debtor’s Malaise

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A mysteriously contracted disease, so named for its frequent confusion with mere laziness or incompetence frequently (typically unfairly) associated with those that find themselves impoverished and in debt for lack of work. Indeed, many with the malaise find themselves out of work and short on coin, but only due to the very real hobbling side effects of the disease. It is thought that chronic exposure to “bad air,” whatever that may mean, is the cause of the disease, which manifests in a slowed mind and body and a persistent feeling of tired, even if in fact well-rested.

    Those affected take long to do essentially anything, and not for a lack of trying – they must frequently stop to catch their breath or to let their muscles rest, and simply cannot react as rapidly as healthy folk. Additionally, though they suffer no consequences for failing to do so more than a normal person, they feel as though they need an almost endless amount of sleep, much to their own frustration and the frustration of those around them. No real cure exists, but in time the disease will fade, assuming one can get away from the “bad air”- whatever the cause. While the precise vector of the Malaise is unclear, a humanoid exposed to it must succeed at a DC 8 Constitution save or become infected.

    A humanoid so infected is utterly unable to recover through natural means from any Exhaustion they may incur. If Exhaustion is suppressed through another means, it returns once that effect expires. The effect of this disease lasts for the duration. Infections last 1d6 weeks, but reinfection from whatever the original source was can happen repeatedly.

    No means of suppression of symptoms exists except for ordinary stimulants, and panacea magical cures for diseases.

    Dionesian Chorea

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    The Chorea remains mysterious – it sometimes seems to appear without reason, while it is known that a certain lovely white flower sometimes found deep in forests will trigger it if its pollen is inhaled by a human. Perhaps the pollen drifts in the wind, or perhaps fey spirits like playing tricks with it from time to time. Whatever the case, it manifests with rapidly emerging exaggerated sociability, a lack of caution, and the gradual development of a sort of jovial irrationality among the infected.

    What is sometimes mistaken as mere lapses in judgement and partying, the disease becomes markedly identifiable once the convulsions and “dancing” begin: a wild jerking, and later animalistic stomping about, entirely uncontrollable by the sickened and followed by brutish violence if any bystanders endeavor to put a stop to it. Eventually, the sick begin to lose themselves, seeking only to continue their “dancing”, happy to use any sort of intoxicants available to fuel their euphoria. If left untended, those so afflicted will die of exhaustion, the side effects of whatever they are consuming, or from unintended self harm in their wrathful frivolity. Humans exposed to the flower must pass a DC 10 Constitution save or be infected.

    On success, they instead feel a short-lived euphoria with no lasting ill effects. Sometimes this is enough to prompt repeated exposure. Those so infected find themselves behaving as above, and are entirely unable to rest after a week, involuntary “dancing” essentially non-stop and crave any mindaltering substance they become aware of nearby.

    Long Rests become impossible for the duration, and they must pass a DC 13 Constitution save or take 1 exhaustion each day, in addition to any incurred through a loss of sleep.

    The disease always lasts precisely 1 week after infection.

    Dockhand’s Ache

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A side-effect of exposure to certain se-borne algal byproducts, especially the sort that might concentrate in stagnant corners of a sea-side port; the cause of this condition is a cyst that briefly forms in one’s back following exposure to such chemicals. This cyst works to aggravate the back, causing inflammation and great pain if the sufferer labors too hard or strains their back too much, which in turn aggravates the muscle further in an endless cycle of discomfort and pain. Many a lazy (or merely overworked) dockhand will claim to have this disease to buy themselves a few easy days of work and an excuse to self-medicate, but the sickness is indeed a real one, best treated by consumption (or inhalation) of certain intoxicating plants.

    Exposure to the cyst-causing chemicals, especially in and around dirty sea-water common near busy settlements, forces humanoids to succeed in a DC 11 Constitution save or be infected. While the cyst is present, infected humanoids have their Encumbrance capacity halved, and generally feel some pain when doing any sort of lifting. The effect lasts 2d6 days while the cyst dissolves, but the effect can be ignored with daily consumption of intoxicating, pain relieving herbs.

    Drunkards’ Rot

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Drunkards’ Rot is caused by a macroscopic amoeba that lies dormant in improperly stored foods that become too wet and then dry out once more.

    Once consumed, the organism makes a home for itself in the throat and begins its work. It subsists purely on the flesh of the throat and, even more so, the tongue, which appears to rot in the owner’s very mouth. The process is gradual, painful, and all too conspicuous. Halitosis and slurred and lisped speech (as though drunk) are common outward effects, but in time the entire tongue will be consumed if left untreated.

    The only effective mundane cure is potent disinfectant, applied generously and frequently to fully cleanse the hardy organism from the body. While numerous substances might do the job, the most readily available and least immediately deadly to the host is strong liquor, consumed generously. Gargling will not ensure the amoebas are exposed. Due to the effects of the disease and the necessary steps to suppress it, this Rot has a strong, if not completely accurate, association with drunkards and alcoholics.

    Indeed, the misery of this disease and the nature of its treatment do seem to create a fair share of drunkards out of folk who had nary a problem prior.

    Exposure occurs through the consumption of contaminated food, as described above. On exposure, a an animal must make a DC 6 Constitution save or be infected. While infected, the creature struggles to vocalize and when it does it is strained and obviously unusual, potentially granting Disadvantage on any vocalization related skill checks.

    Further, the infected creature’s tongue and throat are gradually consumed – if 1d10 weeks without treatment pass, they lose their ability to vocalize entirely. Daily consumption of a liter of antiseptic of strength not less than common spirits (whether alcoholic or not) is enough to suppress the disease for a day. If consumed daily for 1d4 weeks, the infection is purged.

    Eye Rot

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    This foul disease begins innocuously enough after a poor soul is unfortunate enough allow their eyes and ears to be exposed to the stagnant water that hosts the Eye Rot: a pressure in the ears and behind the eyes, like that of common congestion.

    This is naturally followed by an ever more painful earache and conjunctivitis, as the rot takes hold and begins its work of eating away at the soft tissues of the eyes, ocular nerve, and eardrums. The process is slow, at first, when the symptoms appear common and readily treated, then all too fast once the infection takes firm hold. Children are the most susceptible to the Eye Rot, with their early symptoms being taken less seriously, as common maladies of youth. The luckiest of such unfortunates end up with lifelong impaired sight or vision, and often both.

    The worst off end up eyeless, deaf, and perpetually off-balance from the rot. A precise hand must be used to scrape off the infection from the eyes, and a strong solvent must be used to cleanse the ear canals. Exposure occurs through submersion in long stagnant water that hosts the disease. After exposure, a creature must succeed at a DC 8 Constitution save or be infected.

    A creature so infected experiences mundane symptoms as above, but after 1d4 weeks will find themselves unable to effectively see or hear, Blinding and Deafening them for the duration of the disease. After 1d4 more weeks, their inner ear will degrade such that any activity requiring steady balance will be Disadvantaged. After another 1d4 weeks, these effects become essentially permanent, as the tissue is consumed entirely. A weekly DC 10 Medicine Skill Check by another character can suppress progression for 1 week.

    The duration is indefinite, with no readily available medical cure.

    Fainting Ague

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Marked by a sudden jumpiness and anxiety of the infected person, the Fainting Ague is so named for the habit of those afflicted to faint when put under physical or mental stress. This disease is more than a similar mental disorder, but a physical symptom of an infection, and is indeed infectious toward others, though not terribly so. Many infected never even realize they are ill, assuming instead that they are merely particularly skittish and stressed for a period of weeks before they fight off whatever causes this little noted sickness.

    “Bad Air” is the only apt description for the cause of this disease, resulting from polluted and densely populated spaces, not unlike a flu. A humanoid exposed, such as through some else who is infected, must succeed at a DC 9 Constitution save or be infected. Gnomes are notably immune for unclear reasons.

    Symptoms manifest within hours of infection. Someone so infected must make a DC 10 Willpower save any time they enter combat or engage is another activity that causes significant strain or stress on their body or mind. On failure, they go Unconscious, though they will regain consciousness if woken as through asleep or attacked.

    The condition lasts 1d6 days after infection before fading.

    Flesh Lice

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Lice are bad enough, but Flesh Lice are an entirely new level of unpleasant for those afflicted. Not satisfied with merely living on one’s body, these creatures choose instead to live within the first layer of skin, causing extreme discomfort, itching, and a general 9 frailness to the skin.

    It is fortunate that these tiny arthropods are kind enough to secrete a numbing agent wherever they go, such that their coming and going do not themselves cause pain, but the weakened skin does indeed result in painful ripping of the flesh when the host inevitably vigorously scratches the infected sites. Someone so infected finds their whole body more prone to harm, to the point that otherwise harmless blows might cause significant harm. The creatures are resilient, numerous, and sneaky – only complete removal of the tiny beasts will cure this affliction, and removal is a painstaking chore that even the most diligent caretaker can botch if a single breeding pair remains on the body to repopulate another day.

    Infection occurs through exposure to Flesh Lice, on a humanoid or in the wild. Any creature so exposed must succeed in a DC 15 Constitution save or be infected, or alternatively vigorously check themselves after known exposure to prevent any tagalong lice from claiming their body as home. While infected, any physical damage done to the infected creature’s body does 50% more hitpoints than it otherwise would.

    Infections last until treated. Treatment requires a caregiver spending a full day removing the lice from the body and success at a DC 10 Medicine or a DC 15 Perception Skill Check.

    Flesh-Starved Rot

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A disease found only in the filthiest, most corrupted pits of the world, the Flesh Starved Rot is either a fungus or other sort of infection that, once one is exposed, engages in rapid and uncontrolled growth on any fleshy matter it can reach.

    It dissolves flesh quickly, breaking it down in short order to continue its takeover of the corpse. Expansion is so rapid that a patient observer can see the growth of the infection and the disintegration of the flesh with the naked eye. The infection begins on the skin but quickly makes its way to interior tissues, and within a day the infected almost universally perishes, already in an advanced state of decay.

    While a variety of treatments prove effective at stopping the progression of the infection, all require harm to the patient’s body; the disease takes hold so rapidly that it requires whole body treatment, including one’s insides all at once, but to do so is just as deadly to the patient. Unless an exposed extremity can be removed within the first few minutes of infection, this Rot is always fatal, and quite painfully so. Infection occurs after exposure to the Rot, whether dormant or actively consuming flesh.

    Any fleshy organic matter can be afflicted. Something so exposed must succeed at a DC 20 Constitution save or be infected. The rot takes effect immediately, dealing Xd6 damage per turn, where X equals the number of turns since infection.

    The effect persists until death. If, after exposure, the flesh exposed is immediately excised, cauterized, amputated, or otherwise rendered unconsumable by the rot, the infection can be contained or stopped.

    Frog Fever

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    So named for the massive swelling in the infected’s throat glands, frog fever is a debilitating but ultimately not life-threatening malady.

    An infection spread from person to person by sharing cups, food, and…more intimate things, this sickness causes one to feel a persistent sense of exhaustion. While their actual endurance remains unchanged, the unending feeling of fatigue makes performance in all areas of one’s life arduous. The result is someone unable to perform even basic tasks quite to the degree of competence that could be ordinarily expected.

    The most troublesome aspect of the fever is not the symptoms but its term, which can last weeks or more, and the lack of a tried and true means of effective treatment. Infection occurs through contact with bodily fluids of an infected humanoid. On exposure, a DC 16 Constitution save must be passed or the infection sets in.

    Gnomes and Dragonborn are immune. A humanoid so infected always has a minimum of 1 Exhaustion for the duration. The affliction persists for d20 weeks.

    Glutton Worm

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    The tapeworm’s larger, more malicious cousin.

    Glutton worms find their way into the body through contaminated food, taking up residence in the host’s digestive tract. The worms often grow so large as to entirely block one’s intestines, even to the point of distending the host’s belly, such that no sustenance gets through the host without the worm first taking its share – a large share indeed. If left unsatisfied, it will 10 instead leech from the host’s body instead, forcing the afflicted to meet its ravenous demands or find themselves being drained of nutrients and energy.

    In certain parts of the world, these worms are unheard of; the worm has a particular dislike for a certain beverage, coffee (or anything caffeinated), and will voluntarily expel itself from the host if exposed to enough of it. While an unpleasant experience for all parties, the treatment is rapid and absolute, returning the host’s bowels to normal, once their stomach settles. Exposure occurs through consumption of contaminated food or water.

    On consumption, a humanoid must succeed in a DC 10 Constitution save or the worm finds a home in their gut. While infected, triple rations/food must be consumed to keep the worm happy. If less is consumed, it will leech from the body, forcing a DC 15 Constitution save each day, failure of which gives the character 1 Exhaustion.

    Consumption of copious amounts of coffee or any other caffeinated substance in a single day will purge the worm.

    Goblin Gout

    Source FGG:RA

    In goblinoid creatures, this disease causes a level of rabid response, making them likely to bight instead of using their weapons, and irrationally brave in their attacks. They make all attacks with advantage, but all attacks against them have advantage. On any combat round, a diseased goblinoid is 50% likely to attempt to bite its adversary rather than use any other attack. Any creature bitten by an infected goblinoid must succeed on a DC 15 Constitution saving throw or contract the disease. After an incubation period of 1d3 days, the victim develops the symptoms of the disease. If the victim is not goblinoid, the creature develops aching joints and stiffness.

    The victim’s movement is reduced by 20 ft. (5 ft. minimum) and they have disadvantage on attack rolls and Dexterity saving throws and skill checks.

    The victim may attempt a DC 15 Constitution saving throw after any long rest. With two consecutive passes, they shake off the effects of the disease.

    Grunge

    Source FGG:RA

    This disease is spread through contact with goblin-infested waste. It causes blurriness of vision and a slight palsy. Any creature making contact with infected material must succeed on a DC 14 Constitution saving throw or become infected. One hour later, the disease sets in, and the creature has a –1 penalty on all to-hit rolls for 24 hours. A creature who rolls a 1 or lower on their saving throw must make an additional saving throw after 24 hours. A creature who fails this second saving throw permanently loses 1 point of strength. The strength can be regained only with a greater restoration or a wish spell.

    Green Decay

    Source SPCM

    The flesh of a creature that has this disease is slowly consumed by a virulent extraterrestrial fungus. While the disease persists, the creature has disadvantage on Charisma and Wisdom checks and on Wisdom saving throws, and it has vulnerability to acid, fire, and necrotic damage. An affected creature must make a Constitution saving throw at the end of each of its turns. On a failed save, the creature takes 1d6 necrotic damage, and its hit point maximum is reduced by an amount equal to the necrotic damage taken. If the creature gets three successes on these saving throws before it gets three failures, the disease ends immediately (but the damage and the hit point maximum reduction remain in effect). If the creature gets three failures on these saving throws before it gets three successes, the disease lasts for the duration of the spell, and no further saving throws are allowed.

    Hanta Virus

    Source FGG:RA

    The disease is typically caught from contact with rodents and rodent waste. Normally a Constitution saving throw is required to prevent contagion, with the DC dependent on the amount of contagious material contacted and the method of contact. Hanta virus incubates 1d8+7 days before beginning its deadly course. For the first four days after the incubation stage, a creature infected with this disease must make a DC 16 Constitution saving throw every 24 hours. The victim acquires one level of exhaustion for each failure. The exhaustion cannot be removed while the disease persists. Starting on the fifth day, failed saving rolls indicate that the victim loses 2d10 hit points from their maximum as well as gaining a level of exhaustion. Once the disease has been cured, the exhaustion can be cured with rest or by magic, and the loss of maximum hit points is restored after a long rest. Unless cured by magic, this disease is ultimately fatal.

    Hemophilia

    Source FGG:RA

    Hemophilia is typically a genetic disorder and as such is normally only acquired through magical means. A creature who has this disease loses 1 hp per round until magically healed after suffering any bludgeoning, piercing, or slashing damage. The damage lost per round is cumulative with additional sources of damage.

    Hermit’s Pox

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Not all hermits have the Hermit’s Pox, but essentially everyone with it is a hermit. Little is known of how it is spread, but in some societies there is a strong association with lecherous men and the Pox, though it is hard to parse whether this is a cause or effect of the disease.

    Marked by seeping ulcers all over the body, particularly along the extremities and head, which emit a particularly offensive odor of decay, it is hard to bear being near someone so infected for more than a few moments before the smell and sight overtake one’s senses entirely. Unfortunately, it is not just the body but the mind as well that is made unpleasant by this festering disease. In time, the infected becomes easily irritable, selfish, lacking in humor, charisma, or empathy, even while the rest of their faculties remain fully intact.

    The resulting person is one to be avoided, both to avoid spread of the disease and the visual and social misery that the infected becomes.

    Typically, such isolation is a mutually agreeable solution to all parties involved, assuming the ulcers cannot be cleansed in time. Exposure occurs through contact with an infected humanoid’s ulcers. On exposure, success in a DC 10 Constitution save prevents infection. A creature so infected grows painful ulcers and has Disadvantage on all social Ability Checks, both as a result of changes in their own personality and behavior, and the effect their presence has on others.

    A DC 25 Medicine skill check by a caregiver with medical tools can treat the condition.

    Leech Fever

    Source FGG:RA

    This anemia-causing disease comes from the bite of infected leeches.

    It is otherwise not contagious. Anybody bitten by an infected leech must make a DC 16 Constitution saving throw or contract the disease. The disease incubates for 1d3 days before causing symptoms. At this point, the anemia causes two levels of exhaustion. The exhaustion cannot be eliminated while the disease is still active. After the symptoms have developed, the victim may attempt a DC 16 Constitution saving throw after every long rest. Two consecutive successful saving throws indicate the victim has thrown off the disease. The exhaustion can then be removed normally. Lesser restoration or similar magical healing eliminates the disease at any point.

    Lily Palsy

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    The vibrantly blood-colored, two-inch-long larval stage of a wretched necrophagic insect, the Lily Worm thrives on battlefields and in siege trenches – anywhere its adult form can reach by crawling from the slain host it once fed on before laying its eggs in wait. Once consumed by someone, an egg hatches and makes its way to the brain of the infected, where it rests and feeds. Through a combination of painful gnawing and release of neurotoxins, the Lily Worm changes its host’s brain such that their muscles spasm and falter under the right conditions: peaking adrenaline and stress chemicals, accelerated heart rate, vigorous movementthe exact response to violence.

    At first, this manifests as a mere twitch, but with time results in utterly faltering sword hands and bow arms, or in the worst of cases a complete shutdown of the body in a fight. The Worm wants its host slain, that it might emerge among a feast of corpses, gorge itself, and begin the cycle anew. Outbreaks are rare, but if unchecked stand to turn an army of hardened veterans into helpless, jittering cravens.

    Removal of the worm is nigh impossible without releasing a fatal dose of its neurotoxins – it can only be sedated with constant treatment until it is forced to (painfully but not fatally) wriggle free of its host and try its luck reproducing without its feast of corpses – an almost always futile endeavor. Infection is primarily spread through consumption of or exposure of eyes and ears to infested water. Once exposed, a humanoid must succeed in a DC 8 Constitution save or become infected.

    Goblinoids are notably immune to the parasite. A humanoid so infected must make a Constitution save at the start of any combat and every 10 turns thereafter. If they pass at DC 10, there is no effect. If they fail at DC 10, they have disadvantage on all attack actions.

    If they fail at DC 5, they go Unconscious.

    The parasite stays indefinitely without treatment or death. A dose of Basic Poison consumed by the host will purge it, as will any stronger poison.

    Living Death

    Magical terrain, disease, necrotic, airborne

    Source Extreme Encounters Weather & Terrain for 5th Edition (5e) GMs Necrotic

    Necrotic contamination spreads a magical undead disease that turns victims into the “living dead” (and eventually, if not cured, into the undead).

    Infected (Stage 1): Whenever you take necrotic damage from any source, or from claw or bite damage from any undead, you must succeed at a Constitution saving throw with a DC equal to 8 + the damage dealt. If you fail, you are infected with a magical disease called the living death.

    You take 1 level of exhaustion, your speed is reduced by 5 feet, and the wound begins to fester and weep blood and rancid pus. This gives you a -2 penalty to all Charisma-based skill checks for creatures who can see or smell your wound.

    Infected (Stage 2): If you take additional necrotic or undead claw/bite damage and fail a second save against living death, you suffer 1 extra level of exhaustion, your speed is reduced by half, your skin turns gray, and you stink like a corpse. This causes you to suffer disadvantage on all Charisma-based skill checks.

    Infected (Stage 3): If you take additional necrotic or undead claw/bite damage and fail a third save against living death, you take 1 extra level of exhaustion, and act as if poisoned due to the disease racing through your system. You are now covered head to toe in weeping bloody sores and dripping pus. This gives you a -10 penalty to all Charisma-based skill checks.

    In Stage 3, you can no longer heal hit points normally, and must succeed at a DC 15 Constitution saving throw every day or lose 1 point of Constitution. Whenever your score reaches 0, you die and rise as a ghast in 1d4 rounds if you had 4 or more levels, or as a ghoul if you had less. You become undead if you die by any means, not just from the living death.

    Cure: You need a greater restoration or heal to free yourself from living death. If these spells are unavailable, then as long as you consume a gallon of fresh humanoid blood or consume a pound of fresh humanoid flesh (or some combination of the two), or if you bathe in holy water for 1 hour, you automatically make your saving throw that day. However, every time you fail a save against living death afterward, you lose 2 points of Constitution instead as the disease accelerates.

    Duration: This contamination continues in you even after you exit this terrain, and even after you destroy or defeat the primary monster, villain, or relic (etc.) that created the living death.

    Magus Fever

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A runny nose, aching limbs, a gentle fever, a persistent wet cough, and an inexplicable inability to manipulate weavings of magic – these are the symptoms of the Magus Fever.

    To most that catch this disease, it resembles in nearly every respect a mild cold, spread the same as any other. It typically passes in a few drowsy days, perhaps weeks, with the afflicted none the worse save for some fatigue and discomfort. To one in ordinarily in tune with the magical arts, whatever their sort, this fever is another matter altogether.

    Try as they might, whether their magic be of arcane, divine, or chaotic origin, this fever utterly represses their capacity to tap into the grander powers that be, no matter how skilled or powerful their 11 control. This is, of course, a living hell for practitioners of magical arts and foul-intentioned sorcerers alike, who have no way of knowing beforehand whether the courtesan or marauder sneezing next to them has this dreaded fever or something else. Exposure to an infected humanoid can spread the disease.

    A humanoid so exposed must succeed in a DC 11 Constitution save or become infected. An infected humanoid struggles to cast arcane magic, requiring a DC 11 Willpower save to even cast a spell, before determining if its ordinary effects occur. On failure, the spell slot is still expended.

    The disease fades after 2d6 days.

    Marblewife Syndrome

    Source 5e Horror (FGG)

    Though some legends tell of master crafters creating lovers out of stone, this disease was named for such a fable. The disease turns its victims to stone and can be contracted by a not yet petrified victim, as well as during “spore” seasons in which the petrified victim gives off a fungal-like shedding that can further affect other creatures. These seasonal spores complicate attempts to unpetrify victims, which often leads to the destruction or entombment of victims that might otherwise be cured.

    After physical contact with an infected creature, a victim must succeed on a DC 12 Constitution saving throw or become infected. If an infected statue is sporing, a creature that comes within 20 feet of the statue must make the same saving throw. Sporing statues are covered with a flaky substance that resembles dried paint.

    A victim begins to lose points from their Dexterity score at the rate of 2d4 per 24 hour period. If this results in a Dexterity score of 1 or less, the victim becomes petrified. Any means of unpetrifying the victim will also remove the disease, and infected individuals also can benefit from either any means that remove disease or that remove the petrified condition, both of which cure the infected.

    There are dreaded tales of entire cities succumbing to this disease, drawing in the curious and the greedy, only to add to the grim menagerie of lifelike statues.

    Marrow Ooze

    Source 5e Horror (FGG)

    Though not technically a disease, the marrow ooze parasite nonetheless infects its victims with its presence. A marrow ooze enters the body through a wound or exposed orifice (potentially the mouth or ears) while the victim is sleeping, and begins to consume the host’s marrow. The victim can make a DC 13 Constitution saving throw to resist the infection.

    On a success, the marrow ooze escapes avoiding being destroyed by the host’s immune system. On a failure, the host is infected but actually feels better than ever. Infected creatures begin to look more attractive, and are healed of any bone deformities, bone conditions, or diseases of the blood.

    Each day thereafter, an infected creature must make a DC 13 Constitution saving throw. On a failure, the host reduces their hit point maximum by 10, to a minimum of 1. Once the host has reached this minimum, the marrow ooze splits and horrifically transforms the host’s limbs into new marrow oozes in a process that resembles the melting of a piece of wax. The host is left without limbs, but their hit point maximum is restored.

    These victims are at increased risk of developing a traumatic insanity.

    A host that succeeds at two saving throws (they need not be consecutive) can expel the creature, though the expulsion process is painful and difficult.

    Once the expulsion process begins, the host begins to bleed from every orifice and loses body fluids through violent and frequent body emissions.

    This process reduces deals 2d6 piercing and 2d6 poison damage unless the host receives proper medical care (requiring a DC 15 Wisdom (Medicine) check). If a victim should die due to this violent process, their insides are liquefied, and 1d2 marrow oozes emerge from the body.

    Mummy Rot

    Source FGG:RA

    Mummy rot first causes desiccation and then a slow decomposition.

    Vision goes early on as the body loses fluids, followed by ever-increasing weakness. Death comes late, well after the victim is completely incapacitated from weakness.

    When a humanoid is exposed to the disease, either by magical means or through inhaling the dust of a former victim, the creature must make a Constitution saving throw. The DC for the saving throw depends on the power of the curse for magical contagion, and is 14 for breathing grave dust.

    Mummy rot typically manifests immediately with a strong level of thirst. The victim must double its water consumption or gain one level of exhaustion. Every 24 hours, the victim must make a DC 17 Constitution saving throw. Each failure adds one symptom from the table below until death occurs. Two consecutive passes halts the disease but does not remove existing symptoms. Remove curse destroys the disease and heals all damage. A single casting of lesser restoration removes the most recent symptom still present.

    Symptoms in order of appearance based on number of failed saving throws.

    Number of Failed Saving Throws Effect
    0 Thirst — double water consumption or gain one level of exhaustion
    1 Gain one level exhaustion and lose 1d4 points of Charisma*
    2 Vision reduced by 30 ft.
    3 Gain one level exhaustion and lose 1d4 points of Charisma*
    4 Blind
    5 Gain one level exhaustion and lose 1d4 points of Charisma*
    6 Gain one level exhaustion and Charisma is now 1
    7 Lose 2d6 each of Constitution, Dexterity, and Strength*
    8 Constitution, Dexterity, and Strength are now 1
    9+ Lose 1 hp for each failed save until death

    *Charisma does not drop below 1. If Constitution, Dexterity, or Strength drop to 0, the victim is dead.

    Pestilence

    FGG:RA

    The pestilence is typically caught from contact with bodily fluids of a creature carrying the disease. Every round that a creature is in contact with an infected creature or some of its fluid, it must succeed on a DC 14 Constitution saving throw or contract the disease. Anyone infected will begin losing hit points at a rate of one per hour until death. A DC 10 Constitution saving throw is allowed each hour to avoid the hit point loss for that hour, but the process continues afterwards. Magical healing increases the victim’s hit points, but the progress of the disease continues after the curing. Lesser restoration completely removes the disease and return the victim back to health, although it does not restore the lost hit points. If the victim dies from the course of the disease, the body rises as a plague zombie in 1d4+1 rounds. A sprinkling of holy water or a lesser restoration spell cast on the body prevents this from happening. The body may be raised from the dead normally, but not while it is still “alive” as a plague zombie.

    Pig’s Blood Disease

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A “bad air” infection of the blood that causes one to spurt blood more rapidly when cut and prevents the blood from coagulating around a wound to stop the flow- bleeding like a stuck pig. Many will not know they are infected with this disease until the symptoms reveal themselves after a traumatic injury, and often it is too late by that point.

    It is fortunate that treatment is simple, and competent physicians can identify warning signs of someone so afflicted and prescribe treatment to address the risk in advance, removing the cause of the condition and thickening the blood once more so they will only bleed out as quickly as a normal person with a gushing wound might. “Bad Air” is the only apt description for the cause of this disease, resulting from polluted and densely populated spaces, not unlike a flu. A humanoid exposed, such as through some else who is infected, must succeed at a DC 12 Constitution save or be infected.

    A humanoid so infected must make a DC 10 Constitution save any time they take physical damage. On failure, a wound opens, causing them to take 1d4 necrotic damage each turn thereafter. These wounds can be closed with a DC 10 Medicine skill check by them or someone else.

    Multiple wounds can be open on a character at a time, and each damages and must be treated separately. Consumption of large quantities of iron-rich foods suppresses the condition for a day. The infection fades after 3d6 days.

    Prince’s Kiss

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A ‘cousin’ of the so-called frog fever, Prince’s Kiss is a more severe but far briefer form of the malady, primarily associated with kissing and related activities. Onset is rapid, within hours of exposure, and manifests in swollen glands, a high but non-deadly fever, and a perceived intense exhaustion and discomfort at anything that requires effort. The disease would be unbearable but for its brevity.

    Indeed, due to the relatively short infection, many would probably choose this more severe infection over the lengthier, lighter cousin. Still, no one wants to be caught with the Prince’s Kiss – many a philandering spouse has been caught after coming home frog-throated and weary. Infection occurs through exposure to an infected humanoid’s saliva, such as through a bite.

    On exposure, a humanoid must succeed in a DC 20 Constitution save or be infected. A humanoid so infected has no less than 4 Exhaustion for the duration. The effect fades after 1d6 days.

    Rahbas

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A fearsome and almost always fatal disease spread among infected people and animals by saliva, the Rahbas occupies a special place in the folklore of many places. Legends abound of the infected losing themselves and savaging entire families in the night in uncontrolled rage or fending off entire armies as a suicide mission once the disease takes hold. In such legends there are bits of truth to be found.

    The Rahbas unleashes a feral aspect of those infected, which combined with an inexplicable lack of self-preservation makes such souls a nightmare to battle – or live with in the interim. Of course, the value of such ferocity is short-lived, and in time the infected’s brain turns to, as examining physicians digging into cadavers have put it, mush, like overcooked meat in stew. A tragic fate, for there is no known cure.

    Infection occurs through exposure to an infected creature’s saliva, such as through a bite. On exposure, a creature must succeed in a DC 20 Constitution save or be infected. Once infected, the creature must make a DC 15 Constitution save each day or lose 1 Constitution, Intelligence, and Willpower.

    However, they immediately gain +2 to their Strength bonus. Whether these effects are permanent or resolved if cured is a 12 matter of Game Master discretion. Once any Statistic reaches 0, they immediately die.

    The Rahbas is both a curse and disease, and must be resolved as such. No mundane means of medical treatment has any effect.

    Risen Sickness

    Source 5e Horror (FGG)

    Among all disease, few are as feared as risen sickness. Fabled to have toppled empires, this sickness creates undead with staggering efficiency, and at the least ensures a culture of fear and paranoia.

    Even the rumor of risen sickness is enough to rally mobs to stamp it out, and kings have been known to wipe out entire communities as a safety measure, whether it was merited or not.

    What is not certain is how the disease starts, but when it does, corpses begin to rise and hunger for flesh. This disease often spreads to long-dead corpses who have no resistance to the disease whatsoever, and swell the ranks of the risen.

    Walking corpses are considered zombies, replacing their slam attack with a bite attack that imparts the infection (+3 to hit, 5 ft. reach, one target, 1d4+1 piercing damage). These corpses infect their victims with a disease that kills and raises even more walking corpses. An individual exposed to a bite must make a DC 17 Constitution saving throw. Failure means the victim is infected. After every hour of infection, the infected creature loses 2d6 hit points from their maximum. If this maximum reaches zero, the infected creature dies and rises as a zombie within 1 minute of death.

    There is no simple cure for this disease outside of magic, though there are special herbs that can remove the infection before death. An infected victim that is cured is also restored to their normal hit point maximum. There are rumors of random individuals that are naturally immune to the disease, though such tales also say that the immune are carriers, and unwittingly help the spread of the disease.

    Rosen Doom

    Source 5e Horror (FGG)

    The disease known as rosen doom is identified by the haunting reddish hue that affected corpses take on. The blood of the deceased victims also remains a strange reddish color even decades after their death, partially preserving corpses, and retaining the virulence of the disease for just as long.

    This disease is primarily spread through contact with infected blood, although any bodily fluid can transfer the disease. A creature that makes contact with such a fluid must make a DC 16 Constitution saving throw, becoming infected on a failure.

    Symptoms develop within 1d4 days. Infected creatures suffer 1 level of exhaustion. While exhausted, the creature coughs blood and develops weeping sores across their body. At the end of each long rest, the creature must make a DC 16 Constitution saving throw, taking 11 (2d6) necrotic damage on a failure and gaining 1 level of exhaustion.

    On a successful save, the DC of the saving throw is reduced by 1d4+1. When the saving throw DC becomes 0, the disease ends.

    Scholar’s Dropsy

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Caused by a book-loving fungus, Scholar’s Dropsy is a source of nightmares among the great libraries, collegia, and other learned places near and far.

    This exceptionally rare fungus makes its home among neglected and rotting books, its mushrooms sprouting briefly from embedded mycelia before shedding their spores on the edges of long-abandoned pages, where they remain dormant for years to decades, waiting to be disturbed. An unlucky reader who turns those pages is likely to find the spores “taking root” along their nailbeds, invisibly so save for a green tint under the nail. Only when those same spores find their way from the nails to the hosts eyes or mouth does the Dropsy begin, with the fungus sprouting within, causing severe fever and ultimately poisoning the brain such that it swells and overheats to the point of, almost literally, cooking itself.

    While happily among the most treatable of maladies of its class, the effects are catastrophic if left untended, with more than one historically brilliant mind left dumb and drooling after neglecting themselves. Exposure occurs through contact with the mushroom’s spores, typically in rotten books and documents. A humanoid so exposed must succeed in a DC 10 Constitution save or be infected. Elves are immune to infection.

    A humanoid so infected must make a DC 10 Constitution save each day or lost 1 Intelligence (whether permanent or until cured is a matter of Game Master discretion). Treating the disease requires cleansing of the nailbed through removal, fire, acid, or potent antiseptic, followed by consumption of copious amounts of vinegar for 1d6 days.

    Sewer Plague

    Sewer plague is a generic term for a broad category of illnesses that incubate in sewers, refuse heaps, and stagnant swamps, and which are sometimes transmitted by creatures that dwell in those areas, such as rats and otyughs.

    When a humanoid creature is bitten by a creature that carries the disease, or when it comes into contact with filth or offal contaminated by the disease, the creature must succeed on a DC 11 Constitution saving throw or become infected.

    It takes 1d4 days for sewer plague’s symptoms to manifest in an infected creature. Symptoms include fatigue and cramps. The infected creature suffers one level of exhaustion, and it regains only half the normal number of hit points from spending Hit Dice and no hit points from finishing a long rest.

    At the end of each long rest, an infected creature must make a DC 11 Constitution saving throw. On a failed save, the character gains one level of exhaustion. On a successful save, the character’s exhaustion level decreases by one level. If a successful saving throw reduces the infected creature’s level of exhaustion below 1, the creature recovers from the disease.

    Shadowed Typhus

    Source 5e Horror (FGG)

    This magical illness infects a victim’s shadow, causing the victim to slowly become a dark shade.

    This diseases may be contracted if an infected creature stands in your shadow, or by lurking in the same shadow as an infected creature. Creatures of the outsider and aberration type are immune to the effects of the disease, but may still carry and transmit the disease to others.

    Symptoms develop the sunset after contraction.

    At that time, the victim begins feeling weak, and their shadow appears darker than usual. The victim begins to fear any light and feels pain and anguish if exposed to sunlight (this exposure does not cause any physical harm). The creature must make a DC 15 Constitution check to willingly step into any bright light.

    If allowed to linger in the shadows, the disease worsens, and the infected creature begins to look as though they are in the shadows even when in the light. After three days without exposure to any bright light, the creature begins a transformation into shadow that takes place from sunset to dawn after the third day of prolonged darkness. The infected creature becomes a shadow that is able to create other shadows through disease rather than by its strength drain ability (which otherwise remains unchanged).

    The only cure for this disease is prolonged exposure to sunlight (1 uninterrupted hour), radiant damage (equal to half of maximum hit points), or a lesser restoration. Spells and abilities that remove curses or diseases will also end this disease.

    Sight Rot

    This painful infection causes bleeding from the eyes and eventually blinds the victim.

    A beast or humanoid that drinks water tainted by sight rot must succeed on a DC 15 Constitution saving throw or become infected. One day after infection, the creature’s vision starts to become blurry. The creature takes a ?1 penalty to attack rolls and ability checks that rely on sight. At the end of each long rest after the symptoms appear, the penalty worsens by 1. When it reaches ?5, the victim is blinded until its sight is restored by magic such as lesser restoration or heal.

    Sight rot can be cured using a rare flower which grows in some swamps. Given an hour in such terrain, a character who has proficiency with an herbalism kit can locate and then turn the flowers into one dose of ointment. Applied to the eyes before a long rest, one dose of it prevents the disease from worsening after that rest. After three doses, the ointment cures the disease entirely.

    Slimy Doom

    Slimy Doom is caught from contact with the remains of a creature that dies of Tsathoggan Rotting Disease. For each round of contact with dissolved flesh of such a victim, a creature must succeed on a DC 16 Constitution saving throw or succumb to the disease with no initial incubation period. Slimy doom turns a person into goo from the inside out. Each day, the victim must pass a DC 16 Constitution saving throw or lose 1d4 points of their Constitution. At 0 Constitution, they are nothing more than a fleshy bag of pus and bloody foam. Those who are cured by spell or who pass two daily saving throws in a row, must make one additional saving throw for each day they took Constitution damage. If these saving throws fail, the victim has permanently lost a point of Constitution per failed saving throw.

    Slow-Gut Ague

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A mysterious slowing in the entire body’s ability to process substances, Slow-Gut has killed many an unwitting addict after taking their normal dose of their vice of choice only to find their response much more severe than normal. The cause of this disease appears to linger in the blood, as that is thought to be its vector of transmission.

    Whatever the cause, the body seems to fight off the infection given some time, but in the meantime one must be careful about what they consume. Exposure to infected blood can infect humanoids. Goblinoids can carry the disease but are immune to its effects. After exposure, a humanoid must pass a DC 10 Constitution save or be infected.

    While infected, the effects of any intoxicants, poisons, or other non-magical metabolized substances are doubled, whether in severity or term (whatever makes the most sense, at Game Master’s discretion). Infections last 2d6 days.

    Soul Rot

    Magical terrain, disease, necrotic, airborne

    Source Extreme Encounters Weather & Terrain for 5th Edition (5e) GMs Necrotic

    Necrotic contamination spreads a magical fiend disease that causes your soul to rot and turn evil.

    • Infected (Stage 1): Whenever you take necrotic damage from any source, or from any claw or bite damage from a fiend, you must succeed at a Constitution saving throw with a DC equal to 8 + the damage dealt. If you fail, you are infected with a magical disease called soul rot. You take 1 level of exhaustion, your speed is reduced by 5 feet, and your alignment shifts one step closer to evil.
    • Infected (Stage 2): If you take additional necrotic or fiend claw or bite damage and fail a second save against soul rot, you suffer 1 extra level of exhaustion, your speed is reduced by half, and your alignment shifts one more step toward evil. If you are already evil, your alignment now shifts one step closer toward lawful (if a devil infected you) or chaotic (if a demon infected you).
    • Infected (Stage 3): If you take additional necrotic or fiend claw or bite damage and fail a third save against soul rot, your alignment completes its journey to evil if you were originally good, or from law or chaos if you were originally evil. The two levels of exhaustion previously imposed are removed, and you feel better than you ever have – like a brand new version of yourself, free from the chains of your past. You have no desire to restore your alignment and attempt to hide the change from your allies, friends, and family, even as you seek out new, like-minded evil companions. This in no way means you are obligated to be friendly toward the fiend that infected you, or to fiends in general, or to any evil creatures. You might instead become increasingly intolerant and willing to take extreme, selfish measures to ensure your needs and goals are met, the whole time thinking you are a hero and doing what’s necessary or right, or even that your actions are for “the greater good.” Why can’t your old friends and allies understand that?
    • Cure: You need a greater restoration or heal to free yourself from soul rot, but will resist any effort to seek them out or have them cast on you. You prefer lies, excuses, or sneaking away over violence as a means to avoid receiving the cure.
    • Duration: This contamination continues in you even after you exit this terrain, and even after you destroy or defeat the primary monster, villain, or object (relic, etc.) that created soul rot.

    Zombie Fever

    Magical terrain, disease, necrotic, airborne

    Source Extreme Encounters Weather & Terrain for 5th Edition (5e) GMs Necrotic

    Necrotic contamination spreads a magical disease that causes the dead to rise as zombies.

    • Infected (Dead): Any humanoid slain in this terrain by any means rises as a zombie 1d4 rounds later. Its only thoughts are to kill the living to create more zombies. It attacks the living mindlessly and pursues them relentlessly, ignoring everything else, including its own safety. Any humanoid it kills rises as a zombie even if slain outside this terrain – the curse is mobile!
    • Infected (Survived): Any creature wounded by these zombies (but not slain) must succeed at a DC 11 Constitution save after that encounter or be infected by sewer plague (DMG).
    • Duration: This contamination continues until you destroy or defeat the primary monster, villain, or object that created the zombie virus.

    Stomach Parasites

    Source 5e Horror (FGG)

    Invisible to the naked eye, travelers know better than to drink from waters deep in the wilderness for fear of ingesting these stomach parasites. When a creature drinks or otherwise consumes water contaminated by parasites, the creature must succeed on a DC 12 Constitution saving throw or become infected. It takes 1d4 days for symptoms of a stomach parasite to manifest in an infected creature. Symptoms include stomach cramps, taut skin, and extreme muscle definition. Every week, the infected creature doubles the amount of food and water it needs to survive. An infected creature that does not receive enough sustenance regains no healing from short or long rests. A creature can cure the disease with a greater restoration, or an attack or spell that deals 10 points of force damage per week of infection.

    Stumbling Sickness

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    An aggressive infection of the inner ear, stumbling sickness forces the afflicted to pay much more attention to where they step and how they move their bodies, lest they plant their faces on the cobblestone underneath them. Legend tells of an ancient sorcerer who found the disease quite funny once he concocted it and was able to watch the common folk slowly stumble about.

    An inconvenience for most, stumbling sickness is a recipe for disaster for a soldier at march or a ranger on patrol. Fortunately, the sickness is fleeting, often over in a matter of days with no lasting consequences – if the afflicted can spare a few days at a potentially severe disadvantage. Infections are spread through a mild cough. A humanoid so exposed must make a DC 10 Constitution save or become infected.

    An infected character makes all skill checks requiring coordinated mobility at Disadvantage and must move at only half their Movement Speed or force a DC 12 Acrobatics skill check. On failure, they fall prone. The disease fades after 1d6 days.

    Sweating Sickness

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A true scourge of a disease, Sweating Sickness is among the most lethal and least understood in the known world.

    It is ordinarily exceedingly rare, popping up only in small pockets in the footnotes of history, but has been known to follow the warpath of plague worshipping cultists. Once infected, a raging fever sets in within a matter of hours, harsh enough to lay even the strongest and heartiest low. Once the fever hits, the terror and sweat follow, with the poor soul feeling an imminent and unbearable sense of dread such that their heart pounds and sweat drips from their whole body. This is accompanied by an unbearable and unquenchable thirst; no matter how much water is provided, the infected will beg and weep for more.

    Death tends to come swiftly, often within matter of hours, or even minutes, even if treated. Those few that survive are left scarred by the experience, both mentally and physically- as the fever finally breaks black sores break out over the body, replaced by black scabs and later black scars. Though unsightly, these sores are a welcome sight, for they signify the end of the deadly period of the disease. Infection is mysterious in nature, without clear vectors or causes.

    However, a creature exposed must 13 succeed in a DC 20 Constitution save or become infected. Once infected, a creature must make a DC 19 Constitution save each turn. On success, the next Constitution save is 1 point easier. If the DC reaches 0, the fever fades and they recover all symptoms within a few days.

    On failure, they lost 1 Constitution for the duration of the disease, dying upon reaching 0. Only by enduring can the disease be cured. A caregiver on hand gives Advantage to the required Constitution saves

    Telepathitis

    Source 5e Horror (FGG)

    A strange and unusual condition, telepathitis is transmitted by mental contact with an infected creature, or more rarely through physical contact with brain tissue. Such contact requires a DC 13 Constitution save if physical contact is made, or a DC 11 Wisdom save if mental contact is made. Failure results in infection.

    A creature so infected can begin to read thoughts, but does so erratically, gleaning surface thoughts from any nearby creatures. Through mental strain, an infected creature can hone the ability and listen to specific thoughts, as per the spell detect thoughts. They can only use this ability once and regain the ability to do so after each long rest.

    However, this and other mental stressors cause the disease to worsen, and they begin to deteriorate. An infected victim gains an exhaustion level each time they strain to use their ability to detect thoughts and gain an additional exhaustion level if they read the thoughts of a creature with an intelligence score of 18 or higher.

    The infected creature also gains a level of exhaustion if they are around a crowd of 10 or more for more than a minute. With each level of exhaustion gained, the infected suffers from a headache of increasing intensity.

    When the infected creature reaches 6 levels of exhaustion, their head explodes and they die. This can only be prevented by prolonged sensory deprivation and rest. The infected creature cannot have any levels of exhaustion nor be exposed to any thoughts for a minimum of 3 days. If such conditions are met, they are no longer infected.

    Curiously, creatures that resemble brains are susceptible to this disease, which displays more as a wasting cancerous condition. Intellect devourers, grell, and brain consuming creatures are likely vectors for this disease, which sometimes mercifully thins their populations.

    Terror Plague

    Source 5e Horror (FGG)

    Called by some the “rabid fear”, this disease attacks the mind and is spread through bodily fluids, most commonly by sweat. Victims begin to see hallucinations of their darkest fears, often attacking others and spreading infection in an addled attempt to fight off the visions of terror.

    A victim exposed to the body fluids of an infected must make a DC 12 Constitution save or become infected.

    Onset happens during the first evening of infection, and symptoms manifest as visions of dangerous and deadly creatures or hazards, or often the subject of the victim’s phobias or self-doubts. Once these visions begin, the victim sweats profusely, to the point that they drip with sweat. Infected creatures are unable to sleep or rest, and gain no benefits from a short or long rest other than staving off exhaustion. Prolonged infection might result in long-term madness (see madness rules).

    One cure for this disease is to gouge one’s eyes out. Though not a popular cure, it can be a necessary one to stave off madness and sleep deprivation.

    This does not so much cure the disease as it prevents the symptoms, and the victim can still transmit the disease to others (though they do not suffer from the heavy sweat that the visions induce). The only other non-magical cure must be procured from the blood of a hag and requires a DC 20 Wisdom (Medicine) check to properly distill into a working cure. Whatever the connection between hags and this disease may be, it only serves to make each all the more terrifying.

    Tinea Cruris

    Source 5e Horror (FGG)

    Wearing one’s armor too long and going without washing has its consequences in humid environments. When a creature has gone a week without bathing or more than 3 days without cleaning a suit of armor they wear each day, the creature must succeed on a DC 8 Constitution saving throw or become infected. It takes 2d6 days for tinea cruris symptoms to manifest in an infected creature. Symptoms include itching and odor in the groin. The infected creature emits a stench that gives it disadvantage on Charisma ability checks made against creatures within 10 feet. Every week, the infected makes a Constitution saving throw (DC 8 + 1 per previous save) or the range of its stench increases by 5 feet (to a maximum of 20 feet). After 5 successful saving throws the creature recovers from the disease. Whenever the adventurers uncover a new part of the map, the GM chooses from or rolls on the following tables to generate what they find: two geographical areas, two inhospitable terrains, and one warlord.

    Treant’s Rot

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Said to be caught from exposure to ancient, forbidden places deep in the most secret of forest groves, the Treant’s Rot is actually less of a rotting and more of a petrification. Those infected often do not notice the unfortunate situation they have found themselves in for some days or weeks, assuming the small flecks of stony skin appearing on their exposed limb are mere dirt specs.

    In truth, they are bits of skin flaking off, making way for more wholesale petrification of the extremity. In time, from the outside in, both flesh and bone will succumb to such a transformation before eventually snapping off painlessly and permanently. It is unknown why, but the disease rarely spreads beyond the single, originally infected limb, perhaps assuming that the victim has learned its lesson. Even if treated, survivors are left with the scars to prove their trauma- petrified flesh rarely grows back quite the same, even if the function of the extremity is retained.

    Treant’s Rot is a curse that may take hold of trespassers in certain sacred groves and similar sites. One so exposed to the curse must succeed in a DC 12 Willpower save or the curse takes hold. The Rot only impacts one limb in a given exposure.

    Petrification is gradual. Each week, a DC 10 Constitution save to measure its progress must be made. On success, the limb does not progress its petrification.

    On failure, the process advances. After 1 failure, all tasks requiring the use of the limb must be done with Disadvantage. After 2 weeks, it essentially ceases functioning – arms cannot be used to carry things, and a leg is uncomfortable and stiff, halving Movement Speed.

    After 3 weeks, the limb snaps off. The curse can be broken through ordinary means of breaking curses. If so broken, a lost limb will slowly (and painfully) regrow within 3 weeks.

    Trench Worm

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    A small worm-like parasite of perhaps an inch or so in length that thrives in stagnant, turbid water, including the muddy filth that collects in gutters, ditches, and, of course, trenches. It writhes about when disturbed, searching frantically for soft tissue to burrow itself into, and if given time, such as that which is available inside a water-logged boot, embeds itself there. Once a foot becomes infested there are often more worm burrows than skin, and efforts to remove the creatures individually by hand are often met with sloughed off skin and an exposed wound that is more dangerous than the worms! If one wants to keep their skin, the worms must be killed all in short succession and carefully extracted before wrapping the foot to let it heal, with subsequent treatment to stave off infection and rot from within.

    Exposure occurs after an extended period in stagnant water bearing the worms, such as in a trench, without water-proof feet coverings. A humanoid so exposed must succeed at a DC 10 Constitution save or be infected. Dragonborn (and other scaly things) are immune to infection.

    Infections manifest with a day or so of exposure. Over the course of the duration, the infected humanoid’s Movement Speed is halved. Success in a DC 15 Medicine Skill Check by a caregiver with access to surgical tools, access to fire, and bandages can cure the infection outright.

    A creature so-cured will regain their Movement Speed after a long rest.

    Tsathoggan Rotting Disease

    FGG:RA

    This disease comes from a curse and is not contagious. A creature so cursed must make a DC 14 Charisma saving throw to resist the allure of Tsathhogga. Once afflicted, the victim must succeed on a DC 16 Constitution saving throw every 24 hours or lose 1d4 points of Constitution as their insides turn to goo. Passing two consecutive saving throws halts the disease and the ability point damage heals normally at one point per long rest or can be cured magically.

    Watchman’s Blink

    Source Rot, Pox, and Worm Copyright 2022, Tyler A. Thompson and Sad Fishe Games

    Caused by a small, otherwise harmless parasite that resides in the cavity behind the eye, the Watchman’s Blink is the bane of nightguard and hunter, impairing their ability to timely spot threats and quarry with a persistent desire to close their eyes to dull the mild but quite distracting pain the parasite’s presence causes. Reactions are slower, if barely so, and getting the jump on someone becomes harder thanks to such unwelcome companions. Extraction is a simple matter, if unpleasant for the host, and aside from a small scar around the eye the parasite leaves no lasting damage.

    A mercy, compared to some more voracious creatures. The parasite is a certain species of fly larva, its species rare but widespread across a variety of climates. The parent lays its eggs, nigh invisible, as close to the eye as it can.

    Any animal exposed to these eggs must succeed at a DC 7 Constitution save or be infected with the larva. While infected, such animals feel slow to react and must roll twice and take the worse result for all initiative rolls or with Disadvantage in any skill check requiring their rapid reaction to something else. The larva is quick to grow and depart, leaving in 1d6 days as a tiny fly.

    A DC 15 Medicine skill check by someone with medical tools can remove the parasite sooner.

    Madness

    In a typical campaign, characters aren’t driven mad by the horrors they face and the carnage they inflict day after day, but sometimes the stress of being an adventurer can be too much to bear. If your campaign has a strong horror theme, you might want to use madness as a way to reinforce that theme, emphasizing the extraordinarily horrific nature of the threats the adventurers face.

    Going Mad

    Various magical effects can inflict madness on an otherwise stable mind. Certain spells, such as contact other plane and symbol, can cause insanity, and you can use the madness rules here instead of the spell effects of those spells. Diseases, poisons, and planar effects such as psychic wind or the howling winds of Pandemonium can all inflict madness. Some artifacts can also break the psyche of a character who uses or becomes attuned to them.

    Resisting a madness-inducing effect usually requires a Wisdom or Charisma saving throw.

    Madness Effects

    Madness can be short-term, long-term, or indefinite. Most relatively mundane effects impose short-term madness, which lasts for just a few minutes. More horrific effects or cumulative effects can result in long-term or indefinite madness.

    A character afflicted with short-term madness is subjected to an effect from the Short-Term Madness table for 1d10 minutes.

    A character afflicted with long-term madness is subjected to an effect from the Long-Term Madness table for 1d10 × 10 hours.

    A character afflicted with indefinite madness gains a new character flaw from the Indefinite Madness table that lasts until cured.

    Table: Short-Term Madness
    d100 Effect (lasts 1d10 minutes)
    01–20 The character retreats into his or her mind and becomes paralyzed. The effect ends if the character takes any damage.
    21–30 The character becomes incapacitated and spends the duration screaming, laughing, or weeping.
    31–40 The character becomes frightened and must use his or her action and movement each round to flee from the source of the fear.
    41–50 The character begins babbling and is incapable of normal speech or spellcasting.
    51–60 The character must use his or her action each round to attack the nearest creature.
    61–70 The character experiences vivid hallucinations and has disadvantage on ability checks.
    71–75 The character does whatever anyone tells him or her to do that isn’t obviously self-­ destructive.
    76–80 The character experiences an overpowering urge to eat something strange such as dirt, slime, or offal.
    81–90 The character is stunned.
    91–100 The character falls unconscious.
    Table: Long-Term Madness
    d100 Effect (lasts 1d10 × 10 hours)
    01–10 The character feels compelled to repeat a specific activity over and over, such as washing hands, touching things, praying, or counting coins.
    11–20 The character experiences vivid hallucinations and has disadvantage on ability checks.
    21–30 The character suffers extreme paranoia. The character has disadvantage on Wisdom and Charisma checks.
    31–40 The character regards something (usually the source of madness) with intense revulsion, as if affected by the antipathy effect of the antipathy/sympathy spell.
    41–45 The character experiences a powerful delusion. Choose a potion. The character imagines that he or she is under its effects.
    46–55 The character becomes attached to a “lucky charm,” such as a person or an object, and has disadvantage on attack rolls, ability checks, and saving throws while more than 30 feet from it.
    56–65 The character is blinded (25%) or deafened (75%).
    66–75 The character experiences uncontrollable tremors or tics, which impose disadvantage on attack rolls, ability checks, and saving throws that involve Strength or Dexterity.
    76–85 The character suffers from partial amnesia. The character knows who he or she is and retains racial traits and class features, but doesn’t recognize other people or remember anything that happened before the madness took effect.
    86–90 Whenever the character takes damage, he or she must succeed on a DC 15 Wisdom saving throw or be affected as though he or she failed a saving throw against the confusion spell. The confusion effect lasts for 1 minute.
    91–95 The character loses the ability to speak.
    96–100 The character falls unconscious. No amount of jostling or damage can wake the character.
    Table: Indefinite Madness
    d100 Flaw (lasts until cured)
    01–15 “Being drunk keeps me sane.”
    16–25 “I keep whatever I find.”
    26–30 “I try to become more like someone else I know—adopting his or her style of dress, mannerisms, and name.”
    31–35 “I must bend the truth, exaggerate, or outright lie to be interesting to other people.”
    36–45 “Achieving my goal is the only thing of interest to me, and I’ll ignore everything else to pursue it.”
    46–50 “I find it hard to care about anything that goes on around me.”
    51–55 “I don’t like the way people judge me all the time.”
    56–70 “I am the smartest, wisest, strongest, fastest, and most beautiful person I know.”
    71–80 “I am convinced that powerful enemies are hunting me, and their agents are everywhere I go. I am sure they’re watching me all the time.”
    81–85 “There’s only one person I can trust. And only I can see this special friend.”
    86–95 “I can’t take anything seriously. The more serious the situation, the funnier I find it.”
    96–100 “I’ve discovered that I really like killing people.”

    Sample Madness Afflictions

    All of the following samples are from the same 3pp source (TGP)

    Acrophobic

    It’s not an irrational fear of heights if it keeps you alive…

    Short. You have disadvantage on Strength and Dexterity skill checks involving heights.

    Long. You cannot climb or fly more than 10 feet above the ground unless you succeed on a DC 15 Wisdom saving throw.

    Indefinite. “I know I’ll die from a bad fall.”

    Amnesiac

    Memories are like glass, so easily shattered…

    Short. You cannot distinguish enemies from allies and must use your action to attack the closest creature each round.

    Long. You don’t recognize other people or remember anything from before this madness took effect.

    Indefinite. “I’ve forgotten friends, foes, and facts from before this affliction took me.”

    Arcanaphobic

    Magic corrupts and kills…

    Short. You cannot cast spells, use magical items, or be a wilful target of a spell.

    Long. You must succeed on a DC 15 Wisdom saving throw to cast a spell or attune to a magical item.

    Indefinite. “Magic contaminates, I distrust it.”

    Bestial Mind

    In the mind of every man lurks a beast that won’t be chained…

    Short. You cannot cast spells and can only make unarmed attacks.

    Long. When you deal damage, you must succeed on a DC 15 Wisdom saving throw or keep attacking that creature until it is destroyed.

    Indefinite. “The moon answers my howls.”

    Claustrophobic

    The walls are closing in…

    Short. You become frightened of any space smaller than 5-feet wide.

    Long. You cannot pass through spaces smaller than 3-feet wide unless you succeed on a DC 15 Wisdom saving throw.

    Indefinite. “I hate enclosed spaces.”

    Cannibalism

    The nagging lust for human flesh consumes your mind…

    Short. You must use your action each turn to make melee attacks against the closest humanoid enemy.

    Long. When you eat anything other than fresh raw humanoid meat you are poisoned for 1 hour.

    Indefinite. “I enjoy the taste of human flesh.”

    Confused

    The world is a strange place…

    Short. You are stunned.

    Long. When you fail a saving throw, you must succeed on a DC 15 Wisdom saving throw or are stunned until the end of your next round.

    Indefinite. “Very little makes sense to me.”

    Delusions of Grandeur

    It’s great to be a god…

    Short. Give your allies an order. The GM may decide if the task is sufficient or not. You are poisoned until your allies have completed the task.

    Long. You expect protection. When you take damage from a source within 5 feet of an ally, you become stunned until the end of your next turn.

    Indefinite. “They must follow my every command.”

    Deviant

    Society’s norms are a shackle…

    Short. Your alignment changes to the opposite of your party’s average alignment.

    Long. As above, and you have disadvantage on Charisma based skill checks involving lawfully aligned creatures.

    Indefinite. “Rules are meant to be broken.”

    Dissonant Whispers

    The voices whisper eldritch secrets…

    Short. You are deafened by the voices in your head.

    Long. You have disadvantage on Wisdom (Perception) checks involving listening.

    Indefinite. “The voices inside my head tell me terrible truths.”

    Drunkard

    The bottle is your only refuge…

    Short. You are poisoned until you drink alcohol.

    Long. When you finish a long rest, lose 1d10 silver pieces and you are poisoned for 1d4 hours unless you succeed at a DC 15 Constitution saving throw.

    Indefinite. “Being drunk keeps me sane.”

    Fear of the Dark

    The dark is an impenetrable shroud…

    Short. Dim light counts as darkness for you and your darkvision doesn’t function.

    Long. Dim light that is not adjacent to a bright light counts as darkness for you and your darkvision doesn’t function.

    Indefinite. “I’m as blind as a bat after the sun sets.”

    Gambler

    You’ll get lucky, this time…

    Short. You take unnecessary risks, resulting in a –2 penalty to your AC.

    Long. When you take a long rest in an urban area, roll 1d6. On a 1–4, lose 2d10 gold pieces. On a 5–6, gain 2d10 gold pieces.

    Indefinite. “There’s no bet I can’t win.”

    Haunted

    The dead have come to call…

    Short. Enemies that died within the last ten minutes come to life as specters with 1d4 hit points. Undead and constructs are not affected.

    Long. You see ghostly shadows on your periphery. You have disadvantage on Wisdom (Perception) checks involving sight.

    Indefinite. “The dead surround me like ghostly shadows.”

    Hemophobic

    Blood is a disgusting, staining thing…

    Short. You are stunned until the end of your next turn if an ally within 30 feet takes piercing or slashing damage.

    Long. You have disadvantage on Wisdom (Medicine) checks to stabilize dying creatures.

    Indefinite. “I faint at the sight of blood.”

    Homicidal

    Only blood will wash away this rage…

    Short. You must use your action each turn to attack an enemy with a melee attack.

    Long. You must attack the closest enemy unless you succeed on a DC 15 Wisdom saving throw. If you reduce a creatures hp to 0, you continue attacking it until it dies.

    Indefinite. “I love killing more than anything.”

    Hopeless

    Abandon hope all ye who enter here…

    Short. You are frightened of the cause of this madness.

    Long. You have disadvantage on Wisdom saving throws.

    Indefinite. “There is no hope.”

    Insomniac

    There’s no rest for you now…

    Short. You are immune to sleep effects and cannot take a short or long rest.

    Long. You must succeed on a DC 15 Constitution saving throw or gain a level of fatigue whenever you take a long rest.

    Indefinite. “There are more horrors in my dreams, so I stay awake.”

    Kleptomaniac

    So much wealth, ripe for the picking…

    Short. While you are not in melee range of an enemy, you must spend your actions looting.

    Long. When you take a long rest, you must succeed on a DC 15 Wisdom saving throw or attempt to steal from a random ally.

    Indefinite. “I take whatever I can.”

    Masochist

    The pain is exhilarating…

    Short. You cannot willfully accept healing or heal yourself.

    Long. You have a –2 penalty to AC unless you are not wearing armor.

    Indefinite. “Pain reminds me that I’m alive.”

    Mumbler

    The walls have ears…

    Short. You mumble incoherently. You have disadvantage on Charisma based skill checks and can’t cast spells with a verbal component.

    Long. You have a –2 penalty on Charisma based skill checks that require you to speak.

    Indefinite. “They would hear me if they paid attention.”

    Paranoid

    Nowhere to run, nowhere to hide…

    Short. Other creatures can’t use the Help action to aid you and you can’t accept potions from allies.

    Long. You can’t reduce your levels of exhaustion below level 1 when you finish a long rest. You gain a +2 bonus on Wisdom (Perception) checks.

    Indefinite. “My enemies are everywhere. I trust no one and no thing.”

    Pyromaniac

    Fire! Fire, fire, FIRE!

    Short. You can only make attacks with weapons and spells that deal fire damage.

    Long. When you deal fire damage, creature within 5 feet of you must succeed on a DC 15 Dexterity saving throw or take 1d6 fire damage.

    Indefinite. “Fire will burn away all sorrow.”

    Schizophrenic

    A fractured mind sees many strange reflections…

    Short. You are affected as though you failed a saving throw against the confusion spell.

    Long. When you take damage, you must succeed on a DC 15 Wisdom saving throw or suffer the effect above for 1 minute.

    Indefinite. “Many faces define me; I’m always presenting a different one.”

    Selfish

    It is yours, by right…

    Short. You must use your action each turn to acquire as much wealth as possible.

    Long. You cannot cast beneficial spells or give items to other creatures unless you first succeed on a DC 15 Wisdom saving throw.

    Indefinite. “It is all mine!”

    Vampirism

    Blood…

    Short. You can only make bite attacks, which count as unarmed strikes that deal piercing damage equal to 1 + your Strength modifier.

    Long. When you drop a creature to 0 hp with a melee attack, you begin feeding on it and are restrained until the end of your next turn.

    Indefinite. “I crave fresh blood from the living.”

    Curing Madness

    A calm emotions spell can suppress the effects of madness, while a lesser restoration spell can rid a character of a short-term or long-term madness. Depending on the source of the madness, remove curse or dispel evil might also prove effective. A greater restoration spell or more powerful magic is required to rid a character of indefinite madness.

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