Disease

From a widespread plague to the bite of a dire rat, disease is a serious threat to common folk and adventurers alike. Diseases rarely have a limited frequency, but most have a lengthy onset time. This onset time can also be variable. Most diseases can be cured by a number of consecutive saving throws or by spells such as remove disease.
Diseases can be transmitted in one of four ways: contact, ingested, inhaled, or injury.

• Contact: These deseases are contracted the moment a creature touches a diseased object or creature with its bare skin.
• Ingested: These diseases are contracted when a creature eats or drinks tainted food.
• Inhaled: These diseases are delivered the moment a creature enters an area containing such diseases. A creature can attempt to hold its breath while inside the area to avoid inhaling the contagion. A creature holding its breath receives a 50% chance of not having to make a Fortitude Save each round. See the rules for holding your breath and Suffocation. If a creature is holding its breath and fails the Constitution check to continue doing so, rather than suffocating it begins to breathe normally again (and is subject to the effects of the inhaled disease if still in the area).
• Injury: These diseases are primarily delivered through the attacks of certain creatures and through weapons coated in the disease.

Disease Effects

A character must make a save for a disease when they are first exposed to it. A success means that they have avoided contracting the disease and suffer no ill effects from that exposure.
When a creature fails its first save against a disease, they immediately move one step down the disease's potency path (see below). Each time the creature fails a successive save for a given disease, they move one step further down that disease's path, and suffer any other effects listed for that disease. Each disease has a frequency, denoting how often a save is rolled for the disease, and a save requirement, which denotes how many successful Saving Throws (possibly consecutive) are needed to end the disease's progression.
When a disease reaches its end state or sufficient saves are made, the victim stops making saves and suffers no further effects from that disease, though any existing effects remain until properly cured (see below). Some diseases have no end state, allowing the victim to continue attempting saves until they succeed.

Disease Progression Tracks

The disease progression track represents the progressive effects of a disease in the body. A creature who fails a save against a disease moves one step up that disease's track. Most diseases follow one of two tracks, though some rare and deadly diseases may progress along both tracks simultaneously.

Physical Disease Track

Healthy — Latent — Weakened — Impaired — Disabled — Bedridden — Comatose — Dead

• Healthy: A character is healthy until affected by a physical disease.
  
• Latent/Carrier: A character in this stage has the disease, and may pass it on if contagious, but suffers no ill effects.
  
• Weakened: A character weakened by a physical disease suffers all the effects of the Sickened and Fatigued conditions.
  
• Impaired: A character impaired by a physical disease also suffers the effects of the Exhausted condition. Whenever they take a Standard Action, they must succeed at a Fortitude Save at the same DC as the disease's DC or lose the action and gain the Nauseated condition for 1 minute.
  
• Disabled: A character disabled by a physical disease gains the Disabled condition. If they take a Standard Action, their hit points drop by 1 or to –1, whichever is worse.
  
• Bedridden: A character rendered bedridden by a physical disease is awake and can converse, but can't stand on their own or take any Standard Actions or Move Actions.
  
• Comatose: A character rendered comatose by physical disease is Unconscious and feverish. They can't be woken by any means as long as they remain in this state on the disease track.
  
• Dead: The disease overcomes the body's immune system, and the character dies. The corpse may be still be contagious, and some diseases may have unusual effects after the character dies.

Mental Disease Track

Healthy — Latent — Weakened — Impaired — Befuddled — Deranged — Comatose — Dead

• Healthy: A character is healthy until affected by a mental disease.
  
  • Latent/Carrier: A character in the latent stage has the disease, and may pass it on if contagious, but suffers no ill effects.
    
  • Weakened: A character weakened by a mental disease suffers all the effects of the Shaken condition. The DCs of their spells and spell-like abilities decrease by 2. If they are a spellcaster, they can no longer cast their highest level of spells.
    
  • Impaired: A character impaired by a mental disease no longer adds their mental ability score modifiers to the number of uses per day of pools (such as an arcane pool or a ki pool), abilities (such as Channel Energy and lay on hands), and bonus spells per day. Their DCs decrease by an additional 2. If they are a spellcaster, they can no longer cast their 2 highest levels of spells.
    
  • Befuddled: A character befuddled by a mental disease is losing their grasp on thought, reality, and self. They have a 50% chance each round to take no relevant action, instead babbling randomly, wandering off, or talking to unseen things.
    
  • Deranged: A character rendered deranged by a mental disease is almost entirely disconnected from reality. Their mind filters and twists all external stimuli into strange forms.
    
  • Comatose: A character rendered comatose by a mental disease has lost all grip on reality and entered an inner world of dreams. They can't be woken by any means as long as they remain in this state on the disease track.
    
  • Dead: The disease has harmed the character's brain beyond repair, killing them. The corpse may still be contagious, and some diseases may have unusual effects after the character dies.
  
  

  Recovering From Diseases

  When a creature meets the save requirement for a disease, they take no further effects, but their current progress on the progression track stays. Two long rests or one full day of bed rest moves a creature back one level along each track they are currently affected by until they reach healthy. If provided with long term care from the Heal skill, they move back two levels instead.
  Typically, a successful Remove Disease, Heal spell, or similar effect will immediately move the subject back to healthy on their respective track.
  Diseases may apply Conditions to a creature such as Sickened, Fatigued, or Shaken. Effects that modify or remove those Conditions (such as immunities and spells) do not apply unless they apply to the disease causing the condition (i.e. Restoration, Lesser would not remove the Fatigued condition applied by a disease while the disease persists).
  

  Diseases

  The Disease Details article contains a list of commonly found diseases and their effects.