Diseases and Plagues – Sinister Sickness for D&D 5th Edition

EDIT: So, I might clean this up as part of a DM’s Guild post in the near future.  Also, be sure to check out the various creepy creations I’ve made besides this by clicking here.  Please check out my newer content, it’s better!  I assure you!


Journal Entry 183

Illness.  A force capable of wiping out an entire city, if not civilization, if left unchecked.  My superiors theorize that it is the result of the machinations of the lower planes.  I know better though, I’m well aware that life so evil need not come from other planes, but from our prime material.  Sicknesses come from small germ-like creatures, accidentally bred through hosts and environments, but that’s as far as I can gather on my research.  By all means, I’m sure fiends can create their own diseases though… and I shudder at the thought.

That said, I will never rule out an element of the supernatural in plagues.  I’ve witnessed many things while acting as a physician: pustules emitting acidic vapor, coughing fits leading to burning alive, previously rotting and wasting victims returning as the undead, demonic incubation.  The list continues onward.  In fact, some of these cases I plan on covering more in depth, in addition to some new discoveries I’ve made.  I must go back into plagued lands to dive deeper.  However, one can’t venture into these dark depths without proper protection.  As unnerving as it may be to the public, the plague suit has proved quite effective.  Aromatic contents treated with protective wards is helpful enough, after all.  Now, I ready myself for travel throughout the planes, in hopes of understanding disease throughout all realities.

Author’s Note:  My avatar on many of my pages tends to be a plague doctor.  So, what could be more appropriate than analyzing diseases with such a character.  Also, I guess this marks a return to planar and sci-fi content, right?  Plus, one of the things that inspired this was Russet’s Mold and Vegepygmies from Expedition to Barrier Peaks… a module I had previously converted!

Also, be warned!  If you do not like Body Horror or other forms of Medical Horror, I do not recommend continuing.  While I don’t go into grotesque detail, I’ve still tried to capture both to the best of my ability.  And even then, many of the diseases here are quite deadly and have the capability to kill an entire party.  As such, use them sparingly.

Also, please pardon the lateness of this post.  I’ve been under immense stress for the past month and a half.  Things haven’t been going too well for me and I’m doing my best to manage.  That said, things are getting better and I’m trying to make things go back to normal.  As always, thanks for understanding.



Acid Pus –

Only a fool or a determined hero on a crusade would ever wander into the lower planes and the prison plane of Carceri is no exception.  Home to the rejected demodands, shackled souls and some of the worst beings to exist in the multiverse; it should come as no surprise that destructive viral-like infections exist here too.  Exposure to acidic vapors coming from the jungle-like layer of Cathrys in Carceri are not only damaging, but destructive.  Those who afflicted by its burning gasses for too long are infected with its corrosive, fiendish power.  Horrid lumps give way to a horrible acidic ooze, burning away at the flesh.  The slowly festering body is eventually covered and overtaken by said acid, produced against the victim’s will.  If the disease had a level of awareness, it is certain that it wants to devour and melt its victim so it can further spread its fiendish contagion.

Most creatures not native to Carceri (or the Lower Planes for that matter) who remain in Cathrys for more than 24 hours must make a Constitution saving throw (DC 19).  Majority of the victims are humanoids, but some other cases have developed and have been studied.  Failure results in painful lumps forming throughout the body gradually in a hive-like reaction.  This effect manifests almost immediately after the infected is afflicted.  Victims suffer from a – 10ft. penalty to their speed (minimum 5 ft.) as well as have disadvantage on all skill checks.

After 1 day has passed since infection, the target begins to suffer far worse and must make a new saving throw.  Upon failure, the boils get worse and become hideous oozing pustules.  The victim suffers an additional 5ft. penalty (minimum 5 ft.) as well as have disadvantage on attack rolls and saving throws.

In addition, when a creature attacks an infected creature at the second stage of infection, the target must make a Dexterity saving throw as a reaction.  Upon failure, the victim takes 13 (2d12) acid damage and the target becomes Incapacitated in pain for 1 round as one of the boil explodes painfully.  Creatures who die from this disease quickly dissolve into the same evil acids that afflicted them in the first place and can help spread the disease.  Once this has happened, they can only be brought back by the likes of Wish, True Resurrection or other extremely powerful magic.



Combusting Cough –

Crafted long ago by sinister hag covens from distant realms, this plague-like hex burns the victim from the inside-out as they victim vomits a harsh magma.  Slowly but surely, their very bodies are burnt to cinders.

Upon catching combustion cough, the target must immediately make a Constitution saving throw (DC 16).  Upon failure, the sickness begins to take hold.  The victim immediately feels a horrid sensation of flames within their very bodies.  They take 13 (3d8) fire damage and gain 1 level of exhaustion as molten heats carves away at their insides.  While infected, they cannot recover the damage or exhaustion gained by this effect.  The target must make a new saving throw once every 1d4 days and continues to do so until dying, being treated by spells like Greater Restoration and the like or making three successful saving throws in a row.

However, while they are infected, they may projectile vomit magma-like sludge on a foe within 15ft. of them once per short rest.  By doing so, they take 11 (2d10) fire damage (which they may still recover later, unlike the disease’s main effect).  However, one creature within a 15ft. line must make a Dexterity saving throw (equal to 8 + their proficiency modifier + their constitution modifier).  They must target the closest creature within that line.  Failure results in them taking 14 (4d6) fire damage.  The DM may decide if the attack can spread the disease or not, or if it is only contracted by curse.

Variant:  Lower Level.

To use on a lower level party, reduce the DC to 13.  The initial effect deals 5 (2d4) fire damage and the ongoing effect deals 4 (1d8) and the breath weapon deals 7 (2d6) effectively.



Dagger Spores –

While not as immediately threatening as other sicknesses, it’s still both terrifying and disturbing none the less.  Victims face painful barbs growing inside and pushing out of their skin, as a result of a fungal infection.  The barbs slowly grow into sharp protrusions.  If left untreated, the spikes continue to rip apart at the victim’s flesh as they bleed externally and internally.  It’s likely this plague was concocted by vengeful bladelings from the wartorn realm of Acheron as a means of teaching outsiders the meaning of pain at the hands of their bladed flesh.  Some find this bioterror to be disdainful, as it not mocks their look and heritage and because it can lead to their target suffering a dishonorable death.

This illness is contracted by the victim breathing in spores from a rare fungus created crafted in the planar layer of Ocanthus.  Originally produced for biological warfare, plans to use the fungus were later scrapped in favor of other methods.  Once the spores enter the host, incubation phase lasts for 1d6 hours before the initial phase may take place.  Following this, the target loses 10 (3d6) piercing damage and loses that much in maximum hit points immediately as the disease begins to take hold.  While infected, this HP cannot be recovered.  The target must then make a Constitution saving throw (DC 15). Once every 24 hours,the condition worsens as the sharp barbs grow out of the upper layers of the flesh.  The target takes an additional 1d6 damage/HP loss for every day it goes untreated.  Upon losing more than 1/2 of their total health, the fungal aspect of the infection will show through the victim.  Their skin will change color to reflect the Bladelings’ breeds of decomposers as the skin takes on a moldy look.  If the victim’s maximum HP reaches 0, they immediately die and collapse into a spiky fungal mush.  The mush counts as a part of a body for resurrecting purposes, but is no longer a complete body.

In some instances, the fungus will merge with the victim into a whole new creature, the Dagger Fungaloid.  The new creature carries very little resemblance to the original victim, and is merely a fungaloid creature that has rebuilt the victim’s body to suit it. becomes immune to disease and poison; is immune to necrotic and poison damage; is resistance to bludgeoning/piercing/slashing from non-magical weapons; loses all sight and gains blindsight 60ft. instead; alignment becomes lawful evil and its type becomes Plant; may slam (dealing 2d6+strength modifier piercing damage); upon death it can release 30ft. spore cloud that causes new infection (initial DC to avoid = 8 + character proficiency bonus + constitution modifier).  The creature is revived to maximum hit points and is under the control of the DM as a monster.

However, after taking a long rest, the afflicted may save again.  Upon success, reduce the DC by 1d4.  When the DC drops to 0, the fungal infection fizzles out and the barbs die out as well.  The victim will slowly return to normal, for the most part  However, damage to the skin including ruptures and tears will remain and require a spell such as Regeneration to fully fix.  Failure to treat the wounds actively can result in different infections.



Ringing Madness –

The Screaming Void of Pandemonium is a wicked place of relentless winds and deafening insanity.  Those who dare dwell in that plane for too long risk taking the very same shrieks with them. It rips apart at the fabric of their soul, until they’re nothing more than a numb mind and vegetative body.  Some of the Bleak Cabal members that have become immune reportedly use this to their advantage, in an effort to lure their enemies into an endless nightmare of screeching voices.

Any non-native creature (typically humanoid) who stays on Pandemonium for over 24 hours must make a Wisdom saving throw (DC 14).  Upon failure, a cacophony of shrieking and wailing fills the victims head and won’t go away.  After 1 day, they must save again.  Upon failure, they receive disadvantage on all checks using hearing and they gain a short-term madness.  However, this madness lasts 1d10 hours instead.  Upon succeeding, the victim still feels the pain of the constant noise but can manage.  This cycle continues, as the sounds get louder every time the victim fails.  Their level of madness increases until they gain Indefinite madness, as which point the character is also deaf until their ailment is removed.  If they fail a saving throw after that, the character falls unconscious indefinitely and is effectively helpless and can no longer save against this disease.  However, characters who succeed three saving throws are able to fight the disease off.  These successes need not be consecutive.



Plague Daemon’s Curse

Those who wrong the Father of Plagues suffer greatly under his wrath, or so says his scriptures.  He imbues the transgressor with a horrid illness, that while fatal, unleashes something far worse upon the world… one of his spawn.  To cultists of the Plagues Father, this is the ultimate weapon and the perfect means of starting an invasion.  Even assassins and alchemist adept at spreading terror through disease are afraid to go anywhere near such a potentially apocalyptic evil.  Those mad enough to conspire with this dark god proclaim they collect the plague via poisonous sweat secreted from his pours.  No physician is willing to verify this.

Those who are afflicted must make a Wisdom saving throw (DC 18).  Upon failure, they feel feverish and slightly light-headed, but otherwise normal.  The disease incubates until the next time they take a rest.  Their body begins to feel weak and more frail.  They have disadvantage on physical based saving throws, skill checks and attacks.  They are encumbered and their speed is halved.  8d6 hours later, the victim must make a new saving throw.  Upon failure, the victim’s mind begins to fall into insanity.  They have disadvantage on mental saving throws, skill checks and spell attacks.  Creatures have advantage on attacks against them.  This affects saves against the disease as well.  In addition, enemies have advantage on saving throws for spells cast by them.  4d6 hours following that, the victim must save once more.  If failing again, their body begins to give out.  They have disadvantage on death saving throws and they are vulnerable to all damage types. 2d6 hours afterward, the victim must make a final saving throw.  Upon failure, the victim is killed and a Plagueling Daemon emerges from the body’s torso.  If the victim dies at stage three of the disease, the daemon emerges 1d4 minutes later.

The Plagueling Daemon uses the stats of the Goblin (Monster Manuel, page 166) and modify with the following: Damage Immunities: acid, poison; Condition Immunities: disease, poisoned; replace attacks with Bite attack – deals 5 (1d6+2) piercing damage, can spread infection of the same disease (DC 10 instead of 18)

However, upon succeeding on a saving throw four times, the victim is able to fight off the disease and kill the parasite.  These successes need not be consecutive.  Only stronger healing magic can rid the victim of both the disease and the incubating parasite as well.  Spells such as Heal and Regenerate remove all effects.  Greater Restoration will kill the parasite, but will not remove all of the damage dealt to the victim.  They may still make saves to fight it off though.

Variant. Plagueling Curse.

This variant is DC 10, as mentioned above.



Spot of Death –

Many swashbucklers have told a tale of a black dot appearing of a sailor’s hand means death.  There’s much truth to that.  While usually a mad omen that they’ll be killed soon in many stories, other stories tell of a grave ailment that can take one’s life in nearly an instant.  To those who don’t believe it’s a sentence passed by crew, it’s a sentence from something more divine… and their time is short at that point, either way.

This disease is placed upon a character by a curse.  The character affected must make a Charisma saving throw (DC 13) or be marked by the black spot on one of their hands.  The character also suffers a Short-Term Madness.  4d6 hours later, the character must save again.  Failure results in taking 1d6 levels of exhaustion.  Three successes results in the disease no longer actively trying to kill them.  Even if the character ends up surviving the disease, their hand will continue to be marked and those who dislike them are supernaturally tempted to murder them.  Only a spell like Regeneration, Wish or the like can remove the spot and release them of the hex completely.



Swampy Demise –

A foul and upsetting disease.  This disease is found in swamps that have been long since tainted by creatures from planes of Negative Energy, perhaps even other realms built of death and despair.  One such case was in a town called Duponde where an incursion from a realm called “The Shadow Fell” resulted in one such outbreak.  Born of the very essence of death and decay, swampy demise is much like a further corrupted version of pneumonia, a disease common on crystal spheres such as the oddly named “Earth”.  While pneumonia involves fluid in the lungs, swampy demise builds on top of that.

It fills the lungs with necrotic energy, filling canals with tar-like ichor and phlegm.  Eventually, the black substance manifests in other ways, oozing out of orifices and even clouding the eyes.  A victim close to their end looks like they’re overflowing with the hazardous goo.

After the victim catches the infection, they must immediately make a Constitution saving throw (DC 15) or begin to relentlessly cough up a foul black discharge as the victim is stuck in place in pain.  For 1d4 rounds, their speed is reduced to 0.  In addition, they gain the poisoned condition.  Unless they have advantage against disease, they do not otherwise gain advantage, such as the dwarf’s resistance ability.

Following 1d4 hours, the character must save again.  Failure results in losing 1 point of strength as the foul shadowy sludge begins to seep through other parts of the body.  If the creature loses more than 4 points of strength, the ooze reaches the creature’s head; causing them to lose their senses.  Their eyes will be covered as their mouth and ears will be mostly clogged.  Any attempt to speak will unleash dripping slime instead.  Any creature whose strength is reduced to 0 in this manner dies.  Casting Greater Restoration will undo any damage to strength that they might have endured.  In addition, taking a long rest will grant a new saving throw.  Failure does nothing, but success removes 1 point of damage that was suffered.  Greater Restoration or Heal must be cast on a victim whose been healed of all damage beforehand in order for the disease to be removed.

Campaign Option: Variant Zombie Plague.

For added terror, the end result can be like the zombie plague, where the victim will rise as a plague zombie with black ooze pouring from all over their bodies.  These zombies have the Corrosive variant, but deal poison damage instead.



Wendigo Fever

Isolation, starvation, the very heat from your body escaping to the frigid depths.  The victim falls to madness and corruption, as they eventually fall to the taboo of cannibalism.  A fever overtakes them as they undergo a dark metamorphosis, turning them into an evil creature called The Wendigo.

The first time a creature is hit by an attack from a Wendigo, it must make a Constitution saving throw (DC 17).  Failure results in contracting the fever.  No initial symptoms manifest until after a long rest.  Afterwards, the infected suffers one level of exhaustion per day until they eat living flesh from another creature. These levels of exhaustion cannot be cured while the subject is infected.

Upon consuming flesh, they lose all levels of exhaustion and fall unconscious.  Over the course of 1 minute, they turn into a wendigo.  If a creature does not consume flesh and accumulates too much exhaustion, they die and return as a ghoul.  Casting Lesser Restoration, followed by Remove Curse before the creature is corrupted or dies will remove the disease.  Alternatively, enacting on cannibalistic impulses will result in the fever and the symptoms will continue per day until they become a Wendigo.



Wolfen Scourge –

For a long time, it was diagnosed as a variant of lycanthropy.  Such “werewolves” were considered the next evolution, or devolution rather.  In all truth, these creatures are the result of something entirely different.  Brewed by angry beings from a realm of untouched nature, this illness is self-explanatory.  It causes a humanoid to devolve into a wild beast.  Typical method of spreading is through physical contact, but there are other methods of contamination as well.  None have been thoroughly documented as of yet.  One such strange case, that was discovered by planar traveling physicians, is a society of warriors that have colonized a planet containing the accursed plague.  They have used it as a rite of initiation to see if one can overcome it.  Those who failed had degenerated in exile.  It is rumored that the beasts that have bred for battle and transport descended from those consumed by the scourge long ago.

Upon initial infection, the subject becomes irritable and significantly more aggressive.  They must make a Intelligence saving throw (DC 15).  Upon failure, they have disadvantage on skill checks using Intelligence or Charisma that don’t involve intimidation of some sort.  Also, the subject’s teeth become sharper as they become hairier and feral looking.  Their limbs also look stretched and misshapen as well.  The infection begins to become more active over time, as fighting it becomes gradually harder.

The afflicted makes further checks every 1d8 hours.  Upon failure, their traits become more and more wolf-life.  At discretion of the DM, the afflicted may gain abilities of stats matching the wolf or werewolf, as found in the monster manual; such as a bite attack, natural armor, move speed or enhanced senses.  However, they must also roll a d4 for each time they fail the saving throw.  Upon rolling evens, the victim loses 1 point of Intelligence (they cannot drop below a 4).  Upon rolling odds, the victim loses 1 point of Charisma instead (they cannot drop below a 6). As the character’s mind begins to go, they will act more instinctual and less rationally; favoring a more bestial approach to things rather than civilized.  Likewise, the character looks more monstrous and wild over time, looking more like a wolf than their old form eventually.  Casting Lesser Restoration on the victim will cure them of the disease, but not do its effects on them.  Casting Greater Restoration will restore the victim’s mind, while Remove Curse will cause them to return to their original shape.

If the Intelligence drops to a 4 and the Charisma drops to a 6, the creature loses all sense of who they were as they turn into a large sized wolf.  (Use Winter Wolf stats; drop cold immunity, snow camouflage, languages, cold breath; Int is 4, Cha is 6; understands specific commands from languages it knew in life).  Casting Greater Restoration or Heal at this phase of the plague will restore their minds back to normal, but they remain large wolves.

Campaign Option: Great Scourge.

You may choose to increase physical attributes as well, to reflect the Winter Wolf/Warg stats or even the Werewolf.  Alternatively, you may choose to ignore subtraction the Intelligence and Charisma.  You may choose to enable both options, making the plague desirable for power but with the risk of losing one’s self to monstrous evil.



Zombie Plague

The Zombie Plague is a viral contagion capable of wiping out an entire town in less than 1 day.  However, it’s not the initial sickness that causes destruction, but the after effects.  This illness resides in plague zombies, who carry and transfer this illness through their attacks.  It takes 6d10 minutes for the plague to begin to manifest in the victim.  They look deathly and begin to have chills, as it begins to take hold of them.  The victim suffers one level of exhaustion and their maximum hit points are reduced by 1 hit die equal to their maximum hit points gained in a level.

Upon taking a short rest or long rest, the victim must make another save (equal to the Plague Zombie’s DC) or take another level of exhaustion in addition to losing maximum HP as their skin looks rotten and they begin to look like a zombie.  A successful save causes no change.  There is no true way to cure this disease.  The only way to undo the victim turning into a zombie is by casting Gentle Repose on the victim; followed by Raise Dead, Resurrection or a related spell.  However, they still suffer from the effects of the disease and look like a zombie.  Only a Regeneration spell can undo the deterioration they have suffered.

A creature that dies normally or from the disease returns as a plague zombie 1d10 minutes later.  They cease any necrosis as the plague changes to reanimating and invigorating the corpse instead.  For more information on the plague zombie, see here.



IMAGE CREDIT: Plague Doctor – Torvald2000

Made by Doctor Necrotic, for Doctor Necrotic Media.  Warhammer and Warhammer 40K are property of Games Workshop.  Planescape and Dungeons & Dragons are property of TSR Inc./Wizards of the Coast/Hasbro.

Author: Doctor Necrotic

Hobbyist, amateur writer/screenwriter, wannabe-philosopher, music fan, history lover, cinemaphile, gamer, reviewer, and more. I'm a 30 year old hodgepodge of jobs and interests. My current projects on WordPress creating a wide variety of content for various tabletop roleplaying games, even showcasing published content here as well. When I have the time, I also create editorials and reviews spanning various bits of popular culture. I hope you take a moment to check my content out and maybe tell me what you think.

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