Virulent Disease by VaranSL

Virulent Diseases

Most diseases are rarely an issue for the mature adventuring party. Simple castings of lesser restoration can end the suffering of any who are lucky enough to find a Bard, Cleric, Druid, Paladin, Ranger, or Artificer. In fact, a Paladin can end diseases with just a touch, but some diseases are more virulent - maybe it's from magic or maybe because these diseases have become resistant to such magic.

A virulent disease should be a piece of a plot, not something used often on the party. These diseases can't be simply cured by a paladin or a simple spell. Once they get rooted in a creature's system, a disease leaves once the creature has met the requirements for the cure or they receive healing from a specific spell that is listed as part of the disease.

Unless a disease specifies it, it can not be cured with a paladin's Lay on Hands ability or from a casting of lesser restoration, greater restoration, heal, mass heal, or similar spell. If a class, like the monk or paladin, has a class trait that makes them immune to disease, they are immune to a virulent disease.

Using a Disease

Diseases can create an interesting plot hook or clue an adventuring party that not everything is right with a community or settlement. Diseases should be used sparingly, and most diseases that an adventuring party runs into can be easily cured. If a disease is meant to be virulent, then it should be for a reason and provide something additional into the game. These diseases should not be used to take away all of a character's abilities and should have appropriate cures that can be accomplished by the party.

Adventure hooks and plots are provided below.

Sample Virulent Diseases

The diseases below are examples of how a virulent disease could function. Per the DM's discretion, all saving throw DCs, incubation times, symptoms, and more can and should be altered to best suit their campaign.

The King's Disease

This disease seems to only target the wealthy or affluent, leading many to think it is poison from an assassin. In actuality, this disease is simply passed on from exotic spices and fruits that only the very wealthy can ever afford. When ingested, this disease settles in the bowels and begins causing great distress to all who attempt to eat.

A creature is infected by this disease when they eat certain fruits or spices from distant lands that they are not used to. While the individuals in those lands have built up an immunity to the disease, no one has yet realized that outsiders haven't. Once this disease has been ingested, they must make a DC 15 Constitution saving throw or become infected. They have disadvantage on this saving throw if they eat a large amount of food, like having third or fourth helpings. On a successful save, they are not infected.

On a failed save, the disease incubates for 1d4 hours. After that, any time the character eats food or ingests liquids, including potions, they must repeat the saving throw or throw up all food and liquids inside of them. If they ingested a potion, they do not gain the benefits of the potion. While a character is throwing up, they fall prone and are incapacitated for 1d6 x 10 minutes and can't do anything but crawl up to 5 feet each round.

If an infected creature attempts to eat or drink more later on during the next 24 hours, they have disadvantage on the saving throw. If they finish a day without keeping any food or drink down, they suffer one level of exhaustion. For every consecutive day that they finish without food or drink, they suffer an additional level of exhaustion until they ultimately die from exhaustion, hunger, and dehydration.

A creature infected with this disease is often thought to be poisoned by an assassin, and thus it is very difficult to properly diagnose it. To cure this disease, a creature must travel to Arborea and feast on the celestial food grown there.

Leaking Wounds

This disease affects any creature that isn't undead or a construct, though undead and fiends are often carriers for this disease. Those affected by this disease become susceptible to physical damage, causing wounds to never fully heal or close.

This disease is transferred only by physical contact. An infected creature can transfer this disease only through an unarmed attack or using a natural weapon like teeth or claws. If a creature takes damage from an infected creature making an unarmed attack or using a natural weapon, they must make a DC 15 Constitution saving throw after 1 minute of being exposed.

On a failed saving throw to resist the disease, this fast-acting disease begins to attack platelets, dissolving them and, many believe, feeding on it. After 1d4 x 10 minutes, a creature becomes vulnerable to bludgeoning, piercing, and slashing damage due to their body's inability to clot the wounds.

After 24 hours of being infected, an infected creature can attempt the saving throw, on a failed save, the creature loses one unspent Hit Dice. Every 24 hours after that, they must repeat the saving throw, losing additional Hit Dice on a failed save. On a successful save, the creature does not lose any unspent Hit Dice but they are still infected. In addition, if a creature takes a long rest, they do not regain any unspent Hit Dice, but still regains their hit points.

Once a creature loses all their unspent Hit Dice, they succumb to their wounds and die.

To heal from this disease, a creature must be the target of a greater restoration spell in which case, they get a new initial saving throw against the disease, ending the disease immediately on a success. They do not regain any unspent Hit Dice but can take a long rest and regain Hit Dice again.

Magician's Lament

This special disease is attracted to those who can harness spells and seems to grow more powerful as a spellcaster continues casting spells. Those who can not control magic are unaffected by this disease as it works it's way harmlessly through them. Unaffected creatures can still pass on this disease by breathing too close to another creature and most never realize they are carrying the disease.

When a creature who can cast spells comes in contact and breathes in the disease, they must make a DC 10 Constitution saving throw or be infected. An infected creature incubates until they finish their next long rest, though there are no symptoms. Instead, the DM should keep track of every level spell that they cast during the day and on the next day, they do not regain those spell slots. This continues until the creature is robbed of all their spells or the disease is cured. Once a spellcaster no longer has access to level spells, their cantrips are then targeted by the disease, and a random cantrip is removed from them on the subsequent days.

This continues until all their cantrips are taken from them and they can no longer cast any magic. They are then cured of the disease and have permanently lost all ties to magic because of this disease. If a creature cures this disease before they lose access to all their magic, they regain their full access to spells, though their spell slots are not restored until they finish a long rest.

A creature can cure this disease by having feeblemind cast on them, which tricks the disease into thinking that the creature has lost all access to magic. Otherwise, a creature must die before losing all their spells and then be brought back in a new body using a reincarnate or true resurrection spell. If a creature is brought back using true resurrection, they must destroy the original body first, or else the soul will return to its diseased body.

Undead Pox

This disease affects any creature that isn't an elemental, undead, or a construct, though any living creature infected with this disease begins to look like they are undead. Those who suffer from this disease slowly begin rotting away until all that remains is a horrifying undead abomination that has lost any semblance of their former self.

A creature can be exposed to this disease from eating the meat of undead, being bit by an undead transformed by this disease or by interacting with an undead infected with this disease if the creature has fewer Hit Points than their hit points maximum such as rifling through its pockets or removing equipment from the undead.

When a creature is exposed, they must make a DC 18 Constitution saving throw or become infected. The disease incubates for 1d4 hours before their skin begins taking on a ghastly pallor. The DM then rolls 2d6, that result is the number of days a creature has before they completely become undead. Over the next days, the creature begins taking on more and more undead qualities with flesh rotting off their body and an insatiable appetite for raw meat and even brains.

Once the time passes, a creature becomes undead and falls under the control of the DM, the DM should use the stat block for a zombie though they might determine that the undead creature is more powerful than a zombie, though very few retain the abilities they once had in life. Some wizards think that if they can properly control this transition into undeath, they can become a lich but if any have succeeded, they've held that secret close to them.

While a creature is rotting away, but before they turn into an undead, they can be healed by visiting the Positive Energy Plane and burning away the sickness. Another option for infected creatures is to be infected with the positive energies of a paladin's Lay on Hands and the paladin must expend a number of points from their pool equal to the total number of days that the DM rolled times 5.

Once a creature has been turned into an undead, the only way to return them is to destroy the body and then cast a reincarnate, true resurrection, or similar effect that creates a new body for the soul.

Adventure Hooks

A small town in the Shadowfell is having an undead problem as a new disease, Undead Pox, is sweeping through their small community after their graveyard began walking again. They need someone to come in and put the undead back to their eternal slumber and find out where the pox came from.
A strange disease is sweeping through a town only infecting the humans while the rest of the citizens are fine. Due to this being a human-dominant town, there are whispers that the others are trying to kill all the humans and take over the town. As such, humans have forced the other races into a single section of the city and are planning on what to do next. Unfortunately, this hasn't stopped the disease and more humans are dying in even greater numbers than before.
A population is scared, for those who go out at night seem to get struck down with a strange disease that causes their shadow to fall off them.
The dwarves poisoned the ale! Those who drink the local dwarven ale complain of coming down with a horrible sickness that causes them to see hallucinations and be weak in the knees.
A fiend has disguised themselves and is seeking individuals to find a cure to their Sun Blindness. The fiend is hoping to capture a celestial and gather the necessary ingredients for the ritual.
The king is dying and no one can figure out why. Large rewards and even titles of land have been promised to any who can help the king eat.
A strange plague has struck the Feywild, it elicits gloom and dismay on any fey struck with the plague. Even the trees and beasts of the Feywild seem affected, their demeanors apathetic and lifeless.
This disease creates small fungal sprouts in the brain that mind controls a creature. They travel to strange locales in the world and have created a type of cult dedicated to the survival of the disease.

Cures for a Disease

When creating your own virulent disease, think about what might be required to cure the disease. Below are a few ideas.

Must travel to the vistani who have studied such diseases, they can perform a ritual requiring strange materials.
Must be polymorphed into a duck. No one knows why.
Great big jolts of lightning are the only way to cure it.
On the 3rd layer of the Beastlands is the layer of Karasuthra. In its darkened forests is a flower that only grows in the ever-night of this layer, the Moon Lilly.
The touch of a god, even a minor one, is said to be the only way to treat the disease.
A lost civilization was said to have the cure, the history books claim that the city sunk beneath the waves in ancient times.
It's not a cure, but being around cats can suppress the effects of the disease until you can find the real cure.
You must get a withered hand of a lich and wear it around your neck, its undead energies will ward off the disease.

How to use Diseases

Diseases can be used in a wide variety of ways, though the common diseases presented in the Dungeon Master's Guide and in the Monster Manual won't often be a challenge. Instead, they are designed more to be a resource siphon to expend spell slots from clerics and druids, or to remove uses of a paladin's Lay on Hands ability.

These diseases are far more dangerous than the more common specimens and should be used with greater care. When deciding to include a disease into your game, be it a common disease or a virulent one, here are a few suggestions to keep in mind:

NPCs should get diseases first. Player characters should only get the disease after they are aware of it and the dangers surrounding it.
There is always a cure, no matter how esoteric or weird.
In fact, weird cures are for the best. A cure to a disease can be used to take your players to new locations, like the Planes, or anywhere else in your world that you want them to go to.
Avoid putting in too many diseases into your game, but shy away from them.
Virulent diseases should be treated with absolute care. These diseases are powerful and horrifying, if used with little thought you can quickly make a game not fun. Common diseases can be used more often if you have a party that has the necessary resources to remove them.
Diseases can be used as a party resource drain before a big boss fight, though they shouldn't be in every adventure.

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