Down with the Sickness

Hey everyone! I’m taking a quick break from the Prisons for Dragons series to give you a timely article about diseases which is a companion piece for an article I wrote which was just published by the amazing team over at EN World EN5ider.

I know you’ve been thinking, “James, what about diseases? The fifth edition Dungeons and Dragons Dungeon Master’s Guide has only three sample diseases for my game and almost no information about how to craft my own. Will you please help me?” Of course, my friend. Of course.

“Get Sick!” Published

Recently I was fortunate enough to have another article published in EN World EN5ideran online magazine which publishes content for the fifth edition of the world’s most popular tabletop roleplaying game. Included in my article is a lot of advice from me about creating your own diseases and six more sample diseases to add to your game (bottle fever, demonic plague, itching insides, ooze decay, touch of aberrations, and walking rot). This post is a companion piece of my article, “Get Sick.” If you like the rest of this post, go check out the article on EN5ider.

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I have to say, if you’re playing fifth edition and craving more content, EN5ider is a great place to get it. I’m not just saying that because I’ve now written for them twice. You get one short adventure a month plus another three articles with advice on running chases, new druid circles, creating puzzles, and so much more. You get all that for $2 a month. If you don’t want the adventure, you can still score the articles for $1 a month. That’s less than a bottle of water in most places. The articles are of a great quality and EN World creator, Russ Morrissey, writes several of the best articles. You can grab some sample articles and an adventure for free so check it out.

Okay, plug over. Onto some more sample diseases!

Updating the Illnesses

Last year I wrote a post about The Underdark in Exploration Age. Amongst the many hazards Canus’s underground caverns have to offer, one of the most dangerous is diseases. The diseases I created were based on the rules presented in the final D&D Next Playtest packet. Now that we have all the core rule books for fifth edition of Dungeons and Dragons, it’s time to update these little infectious wonders and add to what’s already in the Dungeon Master’s Guide.

New Diseases

The diseases below are meant to be used in The Underdark of an Exploration Age game, but can be added to any Dungeons and Dragons game at the DM’s discretion.

Mushroom Mind

The mushrooms of The Underdark are mostly harmless, but there are those that should be avoided. None more so than the green-spotted murder mushrooms. Humanoids breathing in the spores this fungi risk having them attach to their brains. From there the mushrooms grow within a victim’s skull, slowly reducing mental and physical faculties.

If a humanoid creature breathes in the spores it must succeed on a DC 14 Constitution saving throw or contract mushroom mind. In 1d4 days the first symptoms appear. An infected creature begins to bald and green spots start appearing on their scalp similar to those on the murder mushrooms. Roll 1d6 on the Mushroom Mind Ability Score Damage table to see how much of which ability score is reduced for the creature. The ability score damage cannot be recovered in any way until the creature recovers from the disease.

At the end of each extended rest roll another 1d6 to determine more ability score loss. If one of the infected creature’s ability scores is reduced to 0, the creature dies.

Mushroom mind can be cured with the rare, purple-spotted relba mushroom which grows only on the graves of illithids. A character with proficiency in an herbalism kit who has the kit and 3 ounces of relba mushrooms can spend 1 hour to create one dose of a special elixir. An infected creature who drinks the elixir has the disease is cured at the end of its next long rest. Its ability score damage remains, but can be healed with a restoration spell once the disease is cured.

Mushroom Mind Ability Score Damage
d6 Effect
1 Reduce infected creature’s Strength score by 1d4.
2 Reduce infected creature’s Dexterity score by 1d4.
3 Reduce infected creature’s Constitution score by 1d4.
4 Reduce infected creature’s Intelligence score by 1d4.
5 Reduce infected creature’s Wisdom score by 1d4.
6 Reduce infected creature’s Charisma score by 1d4.
Slug Snot

When adventurers sleep in the open Underdark at night, they would be wise to plug their noses. Brown slugs called drunkbugs are known to crawl into sleeping victims’ noses and travel down their throats into their stomachs. These slugs attach themselves to the lining of the stomach and secret alcohol, thus intoxicating the victim. The victim also produces an excess of mucus which is colored brown, hence the name of the disease.

If a drunkbug crawls into a creature’s stomach, it must succeed on a DC 13 Constitution saving throw or contract slug snot. In 1d4 hours the first symptoms appear. For the duration of the disease the infected creature is poisoned. After 3d4 days of infection the disease the creature dies from alcohol poisoning and the drunkbug lays its eggs in the stomach of the corpse.

At the end of each long rest, the drunkbug relaxes its grip on the infected creature’s stomach and the target is allowed a new DC 13 Constitution saving throw. If the creature succeeds it vomits up the drunkbug and the disease is cured.

Wasting Away

There are special patches of phosphorescent, psionic paritutu mold which grow only in the deepest tunnels of The Underdark. Breathing in the paritutu spores causes wasting away which rapidly ages its victims. Elves and dragons are immune to this disease.

A creature who breathes in the spores must succeed on a DC 15 Wisdom saving throw or contract wasting away. In 1d4 days the first symptoms appear. The creature’s veins glow in the dark and it ages one year.

At the end of each long rest an infected creature must make a DC 15 Wisdom saving throw. If the creature fails it ages one year. If the creature fails three of these saving throws it automatically ages 1 year at the end of every long rest and the disease can only be cured with a wish spell. If it succeeds on three of these saving throws the disease is cured, but the creature remains aged.

Wiped Away

This horrifying disease targets intelligent creatures and is caused by breathing in a magical mist created by The Void. Victims of the disease begin to forget who they are as do the people associated with the infected creature. By the end of the disease it is as the infected creature never lived and then it literally phases out of existence. Troglodytes are immune to this disease.

Those who breathe in the mist must succeed on a DC 15 Charisma saving throw or contract wiped away. In 1d4 days the first symptoms begin to appear. The creature suffers level 1 of the wiped away, described on the Wiped Away Effects table.

At the end of each extended rest an infected creature must make a DC 15 Charisma saving throw. Creatures who fail gain one level of the disease. The creature suffers from the effect of its current level of wiped away as well as the effects of all levels below its current level. If the creature succeeds its disease level is reduced by one. If the creature’s disease level is reduced below 1, the disease is cured.

Wiped Away Effects
Level Effect
1 Infected creature forgets all of its childhood. Others who have met the infected creature only once forget anything about the creature.
2 Infected creature forgets all of its adolescence. Others who have met the creature 10 times or less forget anything about the creature.
3 Infected creature forgets any passions and hobbies it has. The creature’s name and deeds disappear from all records.
4 Infected creature forgets all former romantic partners and lovers and vice versa.
5 Creature forgets all friends and family and vice versa. Creature forgets its own name.
6 Creature disappears in a puff of mists from The Void and no one remembers it ever existing.
The Void

Scholars believe there is something beneath The Underdark called The Void. This space is actually no space at all. It is absolute nothingness. It has the absence of being. There are a few places in The Underdark which are open pits into The Void.

Some nihilistic troglodyte clans worship The Void. They sacrifice victims by throwing them into nothingness and seek to end the pointlessness of existence by finding a way to set The Void free and swallow the world. Those who fall into The Void are never heard from again and cannot be raised from the dead by any means. Perhaps their soul is destroyed, they are alive somewhere within The Void, or transported somewhere else.


If you want to take these diseases with you and put them into your game, use the PDF link below.


If you want to grab this PDF at a later date, it will live in the Free Game Resources section of this site along with monstersD&D fifth edition rules modules, backgroundsspells, magic items, and more.

Don’t forget to check out EN World EN5ider!

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