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Horror Rules / Horror Characters

Horrific Diseases

Source Horror Adventures pg. 146
Diseases hold great potential for horror. They often strike at abilities or traits people value dearly but take for granted. They can leave victims unable to walk or speak, radically change a person’s appearance, and, of course, claim lives. They are impossible to see with the naked eye, and for most of human history, they were poorly understood. Perhaps worst of all, for adventurers, they cannot be fought in the traditional sense and are completely impervious to violence or reason.

While standard diseases in the Pathfinder Roleplaying Game challenge players and make for good storytelling opportunities, they are typically telegraphed days in advance with the first Fortitude save and easily cured with low-level spells. Further, very few diseases are even capable of killing, and often they do nothing more alarming than dealing ability score damage. However, there are worse diseases brewing in the world. This section contains new options for diseases, including a collection of templates that can be applied to any disease to make it more frightening in a variety of ways, and a selection of new diseases that progress through a series of horrifying symptoms, similar to the diseases rules introduced in Pathfinder RPG Pathfinder Unchained.

Disease Templates

Source Horror Adventures pg. 146
Not all strains of the same disease are identical. Diseases mutate and change over time, so the PCs may encounter local strains of devil chills, filth fever, and other diseases that are different from those with which they’re familiar. These different strains might be particularly fast-acting, easier to spread, resistant to treatment, or otherwise improved over the default version of the disease. The following section presents several templates that can be applied to any disease to represent more dangerous strains. These templates function similarly to creature templates, and several templates can be applied to the same disease to create a truly horrifying plague. The special properties of a disease with a template are difficult to predict without special training. Unless a character spends at least an hour examining the disease and its victims and then succeeds at a Heal check (DC = the disease’s save DC + 10), she identifies the disease as its more common variant, without realizing the differences.

Incurable

An incurable disease is all but impossible to cure completely, even with the aid of magic. The incurable template can be added to any disease. The disease retains its base statistics except as noted below.
Save The disease’s saving throw DC is reduced by 5.
Cure The disease cannot be cured with any number of successful saving throws. Whenever the afflicted creature succeeds at a saving throw to resist the disease’s effects by 5 or more, you automatically succeed at your next saving throw against the disease’s effects as well. Even spells that can normally cure diseases only cause the disease to become dormant for 2d4 days, after which the affected creature must begin attempting saving throws to resist the disease’s effects once more. Only powerful magic like a miracle or a wish is sufficient to completely cure a creature of an incurable disease.

Lethal

A lethal disease attacks the host’s body with ruthless efficiency. The lethal template can be added to any disease. The disease retains its base statistics except as noted below.
Save With each failed saving throw, the DC of any future saves by the affected creature to resist the disease’s effects increase by 1. These increases stack to a maximum of 5.
Effect Any Constitution damage or Constitution drain dealt by the disease increases by 2. Otherwise, in addition to its normal effect, the disease also deals 1d4 points of Constitution damage.

Lingering

A lingering disease is one that tends to remain with its victims for a long time and is difficult to cure completely. The lingering template can be added to any disease. The disease retains its base statistics except as noted below.
Save The disease’s saving throw DC increases by 2.
Effect Any ability score damage or drain dealt by the disease is reduced by 1 (to a minimum of 1).
Cure The number of consecutive successful saving throws required for the victim to be cured of the disease increases to double the normal amount.
Special Any effect that would cause a creature suffering from the disease to be cured of it (including remove disease) instead counts as a single successful save for the purposes of curing the disease through consecutive saving throws. No more than 1 successful save can be accrued in this way within a single period of the disease’s frequency (1 day, for most diseases), even if multiple effects would cure the creature of its disease. Finally, even if a creature is completely cured of the disease, small amounts of it remain within its system, and there is a 30% chance per day that the creature becomes reinfected, and must succeed at a new saving throw or contract the disease again. This chance decreases by 5% per day, until it reaches 0%.

Magic-Resistant

A magic-resistant disease is protected against magical treatment. Sometimes this is because the disease has a magical origin or has been infused with magic, and sometimes it’s because the organisms that cause the disease simply react differently to magic than most infectious organisms do. The magic-resistant template can be added to any disease. The disease retains its base statistics except as noted below.
Save The disease can affect creatures that have Constitution scores and are normally immune to disease, whether that immunity comes from a racial trait, class feature, spell, magic item, or other source. However, such creatures receive a +4 bonus on saving throws when attempting to resist the disease’s effects.
Cure The disease is particularly difficult to remove using magic. Remove disease can’t cure the disease, and even more powerful spells such as heal require a successful caster level check with a – 10 penalty (DC = the disease’s save DC) to remove the disease.
Special The disease responds violently to any attempts to heal it using magic. Whenever the diseased creature is subject to a spell or ability that cures diseases, it must succeed at a Fortitude save or suffer the disease’s effect. This does not reset the disease’s frequency, and succeeding at this check does not count toward the number of consecutive saves required to be cured of the disease.

Plague

A plague is a disease that spreads very effectively, and can easily pass through an entire community in a short period of time. If left unchecked, plagues can ravage entire cities or regions, and in the case of particularly deadly or virulent plagues, can potentially even bring an end to mighty civilizations. The plague template can be added to any disease. The disease retains its base statistics except as noted below.
Type If the disease’s type is ingested, it instead changes to inhaled. If its type is injury, it instead changes to contact. If its type is contact or inhaled, it remains the same.
Save The initial saving throw DC to resist the disease increases by 5. The saving throw remains the same for all subsequent saving throws to resist the disease’s effects.
Special Simple contact with or, in the case of inhaled diseases, spending time near a creature infected with a plague can expose others to the disease. If the plague is an inhaled disease, then a creature afflicted with the disease creates an aura of disease around it. Any coughing, sneezing, and in some cases, even breathing releases clouds of disease-causing organisms into the air. Any creature that comes within 30 feet of the diseased creature is exposed to the plague, and must succeed at a Fortitude save or begin suffering its effects. A potential victim must attempt a new save each time it moves within 30 feet of a diseased creature, to a maximum of one saving throw every 10 minutes. Any creatures that remains within 30 feet of the diseased creature must attempt a new saving throw every 10 minutes. If the plague is a contact disease, each time a creature touches the diseased creature, or touches an object that was touched by the diseased creature in the last 24 hours, the potential victim is exposed to the plague, and must succeed at a Fortitude save or begin suffering its effects.

Ravaging

A ravaging disease is one whose effects are particularly difficult to heal, and that can permanently scar creatures affected by it. The ravaging template can be added to any disease. The disease retains its base statistics except as noted below.
Effect If the disease deals ability damage, each time the affected creature fails a saving throw to resist the disease’s effects by 5 or more, 1 point of that ability score damage becomes permanent ability score drain instead. If the affected creature rolls a natural 1 on a saving throw to resist the disease’s effects, all of the ability score damage becomes permanent ability score drain.
Cure The number of consecutive successful saves required to be cured of the disease increases by 1.
Special Ability score damage and drain dealt by the disease cannot be healed as long as the affected creature is still infected by the disease. This applies both to natural healing and magical healing (such as lesser restoration).

Virulent

A virulent disease is particularly fast-acting, and runs its course in hours, rather than days. While this could mean the disease runs its course more quickly, leaving the victim disease-free, virulent diseases are particularly taxing on their victims and often end in death. The virulent template can be added to any disease. The disease retains its base statistics except as noted below.
Onset If the disease’s onset is normally measured in weeks, it is instead measured in days. If it is normally measured in days, it is measured in hours. If it is normally measured in hours, it is measured in minutes.
Frequency If the disease’s frequency is normally measured in weeks, it is instead measured in days. If it is normally measured in days, it is instead measured in hours. If it is normally measured in hours, it is instead measured in minutes.
Effect If the disease doesn’t already deal Constitution damage on a failed save, it deals 1 point of Constitution damage in addition to its normal effect on each failed save. If it normally deals Constitution damage, increase the Constitution damage by 1.
Special If the diseased creature fails two consecutive saving throws, it is sickened until the next time it succeeds at a saving throw to resist the disease’s effects. If the diseased creature fails four consecutive saving throws, it is nauseated until the next time it succeeds at a saving throw to resist the disease’s effects. These penalties are in addition to any other effects of the disease, and cannot be removed as long as the creature remains diseased. Even if the creature is normally immune to the sickened or nauseated condition, that condition still applies; only immunity to diseases protects against gaining the condition from a virulent disease.

New Diseases

Source Horror Adventures pg. 148
The following diseases blend the traditional style of diseases found in the Pathfinder RPG Core Rulebook with the disease progressions found in Pathfinder Unchained. Each of these diseases progresses through a series of stages, from carrier to terminal, and each stage comes with its own horrifying symptoms. The DC listed for each disease is a baseline for the most common form of the disease, but higher-DC strains of these diseases exist, especially in the vicinity of disease-bearing monsters and plague-worshiping cultists.

These diseases do not have onset periods. When the affected creature fails its initial save and becomes infected with the disease, it immediately moves into the first stage of the disease, which is carrier, though it doesn’t suffer the disease’s effect. After this, the affected creature attempts subsequent saving throws at regular intervals, defined by the disease’s frequency, just like any other disease. Whenever the affected creature fails a subsequent saving throw against the disease, it suffers the disease’s listed effect and also moves to the next stage of the disease (progressing from carrier to early, early to moderate, and so on). As long as the affected creature remains diseased, it suffers all of the effects listed for its current stage, as well as the effects of any previous stages. When the affected creature reaches the terminal stage, it can no longer fulfill the cure condition without magic; most creatures don’t survive long at this stage. Whenever the affected creature fulfills the cure condition listed for the disease, it moves to the previous stage of the disease. If this would cause it to move to a stage prior to carrier, it is completely cured of the disease. Any effect that would normally completely cure the affected creature of a disease (such as a remove disease spell) similarly moves the affected creature to the previous stage of the disease instead.

Several of these diseases impose certain conditions at various stages. These conditions can’t be cured as long as the affected creature remains at that stage or a worse stage, even by effects that would normally be able to do so. These effects typically end automatically once the creature is cured of the disease or moves to a less severe stage. Only immunity to disease can prevent these conditions; no other immunities apply against these conditions. Occasionally, a disease might even have an effect that is permanent, and persists once the disease is cured. In these cases, the effect’s description states what measures (if any) can undo the effect, but these measures are generally effective only once the disease has been cured.

Bloody End

This disease causes the body to produce blood filled with sanguine humours and adrenaline, making the victim incredibly violent and savage. It is spread by contact with the tainted blood—so while it is safe to touch creatures in the early stages of the disease, coming into contact with even the smallest amount of a diseased creature’s blood allows the disease to spread.
Type disease, contact; Save Fortitude DC 20, see text
Frequency 1/hour
Effect –2 penalty to AC and on Reflex saves and Will saves for 1 hour; Cure 2 consecutive saves

Stages

Carrier The affected creature becomes more irritable and aggressive than normal, but otherwise there are no symptoms of the disease at this stage.

Early The affected creature’s skin darkens, and the creature’s attitude worsens, making it prone to violent outbursts. The affected creature gains a +1 alchemical bonus on attack rolls and damage rolls, and takes a –2 penalty to its Armor Class. Its tainted blood is unable to clot, and rushes out of even minor wounds. Whenever the affected creature takes at least 5 points of piercing or slashing damage, it also takes 2 points of bleed damage. This bleed damage stacks with other bleed damage, including itself. Whenever the affected creature takes bleed damage in this way, a thin but far-reaching spray of blood erupts from the wound, exposing all creatures in a 15-foot cone (pointing toward the source of the attack) to the disease unless they succeed at Reflex saving throws at the disease’s DC.

Moderate Blood begins to ooze through the affected creature’s pores, coating its skin in a thin, red sheen. The alchemical bonus on attack rolls and damage rolls increases to +2, and the penalty to the creature’s Armor Class becomes –4. Whenever the affected creature takes damage, it must succeed at a Will save at the disease’s DC or fly into a berserk rage, in which it is compelled to attack the nearest creature each round for 1 minute, regardless of whether it’s a friend or foe. The amount of bleed damage the affected creature takes after being dealt 5 or more points of piercing or slashing damage increases to 5.

Severe The affected creature is constantly staggered. Additionally, the berserker rage caused by the disease clouds the mind of the affected creature, which is constantly compelled to attack the nearest creature. The affected creature can attempt a Will save at the disease’s DC as a free action to suppress this effect for 1 minute, but if it fails this save, it can’t try again for 1 hour; even if it succeeds, it must continue to attempt a save whenever it takes damage to avoid flying back into a berserk state.

Terminal The affected creature can no longer attempt a saving throw to suppress its rage. If it fails a saving throw against the disease’s progress at this stage, it dies. Even on a successful saving throw, the affected creature takes 10d10 points of damage and 2 points of Constitution drain. If the affected creature dies at this stage, its body explodes in a shower of gore, exposing all creatures within 20 feet to the disease unless they succeed at Reflex saves at the disease’s DC.

Brain Moss

This bright blue fungus grows inside the brain tissue of a living creature, altering the brain’s chemistry to make the host docile, and eventually consuming the host’s brain while it is still alive. In severe cases of the disease, telltale blue fuzz can often be found growing out of the victim’s ears and nostrils.
Type disease, inhaled; Save Fortitude DC 16, see text
Frequency 1/day
Effect –2 penalty on Will saves and Wisdom-based skill checks and ability checks for 1 day; Cure 2 consecutive saves

Stages

Carrier At this stage, the affected creature experiences colors and sounds with more intensity than it normally would, but there are otherwise no effects.

Early The affected creature’s mind is flooded with calming chemicals, which put the creature in a tranquil, calm state. The affected creature cannot gain any morale bonuses or penalties, and it takes a –2 penalty on attack and damage rolls. Additionally, the creature takes a –4 penalty on Sense Motive checks, as the brain moss interferes with critical thinking.

Moderate The affected creature becomes placid and incredibly impressionable. It cannot take hostile actions, although whenever another creature takes a hostile action against the affected creature, it can attempt a Will save at the disease’s DC to suppress this effect for 1 minute. Additionally, whenever anyone makes a request of the affected creature, it must succeed at a Will save at the disease’s DC or be compelled to perform the request, similar to a creature that failed a saving throw against the suggestion spell, except this suggestibility is a nonmagical disease effect (not a spell, spell-like ability, enchantment, or compulsion).

Severe The fungus begins to cause intense hallucinations in the affected creature, making it constantly confused. Additionally, once every 1d4 hours, it has a hallucination that causes it to be dazed for 1 minute, after which time it must succeed at a Will save at the disease’s DC or be compelled to perform an act chosen by the GM or determined at random, as a result of the delusions (similar to the effect at the moderate stage).

Terminal The fungus begins to consume the brain tissue of the affected creature, whose brain can no longer control its body. The affected creature falls unconscious and remains unconscious for as long as it remains at this stage of the disease. If it fails a saving throw against the disease’s progress at this stage, it dies. Even if it succeeds at a saving throw at this stage, it takes 4 points of Constitution and Intelligence damage.

Ghoul Distemper

This rare, tropical disease causes living creatures to turn into feral, ghoul-like entities, and when fatal, often causes the affected creature to rise as a ghoul. The creature’s metabolism rises at an incredible rate, forcing it to devour untenable amounts of food. Eating only further fuels the disease, and all victims of this affliction quickly develop an emaciated, corpselike appearance.
Type disease, ingested, inhaled, or injury; Save Fortitude DC 18, see text
Frequency 1/day
Effect –2 penalty on Fortitude and Will saves for 1 day; Cure 2 consecutive saves

Stages

Carrier The affected creature becomes voraciously hungry, and must consume double the normal amount of food each day it remains at this stage or risk starvation.

Early The affected creature’s skin turns a deep shade of yellow, while the creature’s temperature begins to rise. Additionally, the affected creature’s ravenous appetite worsens. As long as it remains at this stage of the disease or worse, it treats each hour as though it were a full day for the purposes of the frequency and amount of food it must eat in order to avoid starvation (including time spent sleeping). Finally, it develops a strong craving for raw meat, and must consume at least 4 ounces of uncooked meat per hour or become sickened until it does so.

Moderate The affected creature’s body begins to quickly waste away, as muscle and fat are consumed to feed its growing hunger. Further, its body begins to constantly exude a stench of rotting meat, which cannot be removed with any amount of bathing. The affected creature is constantly sickened. Additionally, whenever the creature takes nonlethal damage from starvation, it takes 3d6 points of damage, rather than 1d6. Finally, whenever it comes within 10 feet of any amount of meat, including the bodies of slain creatures, it must succeed at a Will save against the disease’s DC or be compelled to spend 1 minute gorging itself on the meat.

Severe The affected creature’s teeth begin to grow and twist painfully, fusing together to form four massive fangs. The creature gains a primary bite natural attack that deals 1d6 points of damage (1d4 if Small). Further, its hunger-addled mind drives it to favor this attack over all others. It can no longer cast spells or use other activated special abilities, nor can it use manufactured weapons; it is able to make only full attacks with its bite and other natural attacks. Finally, whenever the affected creature takes nonlethal damage from starvation, it takes 6d6 points of damage, rather than 1d6.

Terminal The affected creature completely loses control. It is compelled to attack any living creature it encounters in an attempt to devour its victim’s flesh, preferably while still alive. Player characters who reach this stage are under the GM’s control until they are cured. Additionally, whenever the affected creature takes nonlethal damage from starvation, it also takes 2 points of Constitution damage. If it fails a saving throw against the disease’s progress at this stage, it dies. A creature that dies while at this stage of the disease rises as a ghoul (or ghast, if it had 5 or more Hit Dice) after 24 hours.

Gore Worms

These parasites derive their name from their habit of devouring their hosts from the inside, leaving them as putrid sacs of blood and worms. Gore worms release their microscopic eggs in sporelike clouds that make their way into the bloodstream when inhaled. Eventually, the eggs anchor themselves within a host’s body and grow until they reach nearly 2 inches in length. Adults burrow out through the host’s skin and release their eggs into the air. The worms cannot survive outside of a host for more than a few hours, though they can inhabit corpses as easily as living creatures.
Type disease, inhaled; Save Fortitude DC 20
Frequency 1/day
Effect –2 penalty on attack rolls, damage rolls, and Fortitude saves for 1 day; Cure magic only

Stages

Carrier The gore worm eggs travel throughout the creature’s body via its circulatory system. The affected creature doesn’t suffer any particular symptoms at this stage.

Early The affected creature develops swelling, blisterlike growths that ooze blood and are incredibly painful when touched. Whenever the creature takes bludgeoning, piercing, or slashing damage, it takes 1d6 additional points of nonlethal damage. Additionally, if the creature is wearing armor, then whenever it takes a standard action, it takes 1d6 points of nonlethal damage, or 2d6 points if wearing heavy armor.

Moderate The gore worms hatch. The affected creature can feel them writhing and moving beneath its skin, and others can even see the worms moving occasionally. The affected creature is constantly sickened. Furthermore, whenever it takes more than a single standard or move action in a round, the worms roil angrily, causing the host to become nauseated for 1d4 rounds afterward. Finally, magical healing greatly agitates the worms, and whenever the affected creature is the target of a spell with the healing subschool, the worms whip into a frenzy, dealing 2 points of Constitution damage.

Severe The gore worms burrow holes through the affected creature’s skin and extend portions of their bodies out into the air, giving the appearance that the affected creature’s body has been covered in dozens of tiny gaping mouths with serpentine tongues. The affected creature is constantly staggered and exhausted.

Terminal The gore worms begin devouring the affected creature’s internal organs. The affected creature is constantly nauseated. If it fails a saving throw against the disease’s progress at this stage, it dies. Even if it succeeds, it takes 10d10 points of damage and 2 points of Constitution drain, in addition to the disease’s normal effects.

Skin Wastes

This disease brings intense itching, then hardening and cracking of the skin, and eventually the transformation of all soft tissue to bone.
Type disease, contact; Save Fortitude DC 20, see text
Frequency 1/hour
Effect –2 penalty to AC and on Fortitude and Reflex saves for 1 hour; Cure 2 consecutive saves

Stages

Carrier The affected creature suffers from itchy, irritating skin, and localized, splotchy rashes. At this stage, the disease has no mechanical effect.

Early The affected creature’s skin becomes gray and flaky. The itchiness caused by the disease worsens, and the creature must succeed at a Will save at the disease’s DC each waking hour or frantically spend much of that hour scratching away at its skin. For each failed Will save after the first in the same day, the creature takes 1d6 points of damage, as its scratching begins to break the skin and leave bloody gouges.

Moderate The itching intensifies, and the amount of damage dealt by scratching increases to 1d8. Additionally, during combat and other stressful situations, the affected creature must scratch its skin each round as a move action that provokes attacks of opportunity. Each round, the affected creature can suppress the need to scratch that round with a successful Will save at the disease’s DC, but if it attempts the saving throw and fails, it spends the entire round scratching.

Severe The affected creature’s skin becomes cracked and broken, and even moving is incredibly painful. As long as the creature remains at this stage, the affected creature is sickened and staggered. Additionally, whenever the affected creature takes damage, it takes double the amount of damage it normally would.

Terminal The affected creature’s skin and organs slowly transform into solid bone, until eventually the creature is effectively petrified. The creature is constantly nauseated. For the first 24 hours at this stage, its Dexterity score is reduced by 1 each hour. During this time, its skin and organs transform into a single, solid mass of bone. Once its Dexterity score reaches 0 or after 24 hours have passed, it is petrified. A stone to flesh spell can undo the petrification, but the creature must immediately succeed at a Fortitude save against the disease’s DC to survive the change. Even if it does, its Dexterity is again reduced by 1 each hour, and it eventually becomes petrified once more unless cured of the disease.