Tuberculosis

Common Disease

Lethality: Medium

Transmissibility: High

Tuberculosis has long periods of latency, where symptoms are not readily apparent even though a creature is still infected.

Infection

This slow wasting disease, also called “white death,” spreads through coughing, sneezing, spitting, or sometimes only speaking. The tendency to pass between people living in close proximity often leads to whole families contracting Tuberculosis, slowly growing weak and ill after one member of the family suddenly dies coughing up blood. Due to these strings of illnesses, rumors of Vampirism often follow in the footsteps of the illness. The fact that garlic is effective in treatments has only added to the confusion. This can lead to people hiding symptoms, or failing to receive proper treatment, which allows the disease to spread further.

Outbreak

1d4 people near a creature with early or active Tuberculosis contract the early form of the disease unless they already have Tuberculosis.

Symptoms

Tuberculosis has three stages of progression. Some people experience no symptoms until the third, lethal stage of infection, called “active tuberculosis.”

Early Tuberculosis

When the creature is first exposed to the disease, the player must make a DC 26 END check. On success, the creature has no symptoms during the early stage and cannot transmit the disease. On failure, Day 1 of symptoms occurs 2d20+20 days after exposure. The patient can transmit the disease while coughing persists. The following effects are cumulative.

• Day 1-3: Persistent cough. Gain Fatigue.
• Day 4-8: Sore throat, low fever. Gain Chilled.
• Day 9-14: Headache, shortness of breath. Gain Sickened.
• Day 15-19: Creature must rest to begin recovery on Day 20. Otherwise, symptoms will persist until the creature has five consecutive days of rest.
• Day 20: Remove the Sickened condition, headache, and shortness of breath.
• Day 21-22: Remove the Chilled condition, sore throat, and fever.
• Day 24: Remove the Fatigued condition and cough.

Condition Bonuses and Penalties:

Following early Tuberculosis, the creature enters an asymptomatic period called “latent” Tuberculosis, and over time may succumb to deadly, “active” Tuberculosis. This progression may take months, or even years. Throughout both these periods, certain factors will negatively impact the creature’s condition or treatment, and certain factors will positively impact them.

The following are positive factors:

• Sunlight.
• Warm, dry air.
• Taking a Rest.
• Sufficient food.
• Clean, airy living space.

The following are negative factors:

• A Chilled, Fatigued, Paralyzed, Sickened, or Suffocating condition not from the disease.
• Death Points.
• Cold or damp environments.
• Inadequate food.
• Confined or crowded living spaces.

Latent and Active Tuberculosis

In advanced Tuberculosis infections, creatures have their max HP, spellcasting ability, and ability to use magic items reduced, as well as contracting mundane symptoms. Symptoms are cumulative.

When the creature’s max HP reaches 0, they die over the course of 14 days with no further possibility for mundane treatment. Greater Restoration and similar magic can restore their HP max to 10, allowing for the possibility of mundane treatment.

• Stage 0: Latent Tuberculosis. No symptoms. Creature cannot transmit the disease.
• Stage 1: Active Tuberculosis. Persistent cough, mild fever. The creature can transmit the disease. Gain the Chilled and Dazed conditions. The creature’s max HP is reduced by 1d4, and its max SP is reduced by 5.
• Stage 2: Coughing up blood spots, chest pain while coughing. Gain Fatigue. The creature’s max HP is reduced by 1d4, and its max SP is reduced by 5. Its Essence Point max is also reduced by 5.
• Stage 3: Appetite loss, weight loss. Gain the Sickened condition. The creature’s max HP is reduced by 1d4, and its max SP is reduced by 5. Its Essence Point max is also reduced by 5.

• Stage 4: Constant chest and throat pain. Gain the Staggered condition. The creature’s max HP is reduced by 2d4, and its max SP is reduced by 5. Its Essence Point max is also reduced by 5.

• Stage 5: High fever, coughing up mouthfuls of blood. Intense pain in one randomly determined part of the body other than the chest. Gain the Helpless condition The creature’s max HP is reduced by 2d4, and its max SP is reduced by 5. Its Essence Point max is also reduced by 5.

• Stage 6: Emaciated, difficulty standing, fits of confusion. In combat, the creature has the Suffocating condition that ends when they begin to Catch their Breath. Per failed status roll (see “Advancing Stages”): The creature’s max HP is reduced by 3d4, and its max SP is reduced by 5. Its Essence Point max is also reduced by 5.

Advancing Stages

Every 14 days, make a DC 26 END check to determine whether the creature will remain at their current stage of Tuberculosis or, on a failed check, progress to the next stage. The creature receives the following bonuses and penalties:

• Add their current stage of Tuberculosis to the DC.
• Add a bonus of +1 to the creature’s roll for each positive factor present in the last day of game play.
• Include a penalty of -1 to the creature’s roll for each negative factor present in the last day of game play.

At the end of any day when the creature incurs a Death Point or condition listed under negative factors, the creature must make an additional status roll to avoid progressing to the next stage of Tuberculosis unless the creature immediately Takes a Rest in a warm, dry location with sufficient food.

Death Points and negative conditions are cumulative for the purpose of penalties. Each Death Point or effect results in a penalty of -1 to the player’s END check. However, the player should make only one status roll to progress to the next stage of Tuberculosis regardless of the number of negative factors incurred.

Creatures in Stage 6 Active Tuberculosis cannot progress to a more advanced stage. On failure to pass their status roll, they repeat max HP, SP, and Essence Point penalties for Stage 6, and the DC for future status rolls goes up by +1.

Treatment

The disease has a long-lasting latent period and is endemic across most continents. Approximately one in ten people have a latent Tuberculosis infection without realizing it.

Tuberculosis requires significant time and application of medication to treat, with the requirements increasing depending on how advanced the infection has become. It remains treatable until the creature reaches max HP 0.

Treatment Bonuses and Penalties

Refer to the list of positive and negative factors under “Symptoms.” As with status rolls, these provide bonuses and penalties to treatment checks.

• Each positive factor present is -1 to DC
• Each negative factor present is +1 to DC. Multiple Death Points or status effects accumulate multiple penalties.

General Requirements 

The doctor treating the patient must make an INT/Medicine check once per day using the treatment base DC in the Treatment Details table and any applicable bonuses or penalties. If a treatment check fails, the doctor may retry treatment one time per day with a DC penalty of +2.

The creature with Tuberculosis must also take a specially prepared medical potion made with abundant quantities of fresh herbs and fresh garlic, purchased at the material’s cost in the Treatment Details table. The person making the medication must pass an INT/Medicine check using the medication DC in the Treatment Details table. Provided a doctor leaves instructions for preparing the medication, another creature may substitute an INT/Alchemy check of the same DC. Antibiotics from a Plague Doctor may substitute for this. Penicillin from a Plague Doctor will reduce the times in the Treatment Details table by 1⁄2.

The creature with Tuberculosis must receive successful treatment and the indicated number of successfully prepared doses of medication each day for the full number of days listed under “Days to Treat.” Failure to treat Tuberculosis, either through not succeeding at the appropriate treatment checks, not seeing a doctor, or not taking required medication, will cause a relapse. See details under “Relapses.”

Doctors may wear plague masks, have caretakers without previous exposure wear plague masks, or recommend that patients with active symptoms wear them while in company to prevent transmission of the disease.

Treatment Details

Stage	Treatment Base DC	Medication Base DC	Material Cost	Medication Dosage	Days to Treat	Progress To
Early Tuberculosis	20	15	20 sc	1/day	30 days	Cured
Latent Tuberculosis (Stage 0)	22	15	25 sc	2/day	60 days	Cured
Stage 1	24	16	30 sc	2/day	30 days	Stage 0
Stage 2	26	16	35 sc	2/day	45 days	Stage 1
Stage 3	28	17	40 sc	3/day	60 days	Stage 2
Stage 4	31	18	45 sc	3/day	75 days	Stage 3
Stage 5	34	19	50 sc	3/day	90 days	Stage 4
Stage 6	38	20	50 sc	4/day	120 days	Stage 5

Early Tuberculosis

Every successful day of treatment for early Tuberculosis will advance the symptom timeline by 3 days. Creatures should be asymptomatic within 8 days, but should continue treatment. If the patient completes the required 30-day treatment, they are cured, and do not contract latent or active Tuberculosis. For creatures who do not complete treatment, see “Relapses.”

Latent and Active Tuberculosis

Each stage of Tuberculosis requires a progressively higher standard of care. As the creature recovers by following the treatment schedule in the Treatment Details table, they will continue through the milder stages of the illness. Recovery from advanced Tuberculosis can be a long, arduous, and expensive process. The creature will only reach the “Cured” condition after completing treatment through Stage 0, or Latent Tuberculosis.

Following one day of successful treatment, the creature may stop making status rolls to move to a more advanced stage of Tuberculosis. For failure to complete treatment, see “Relapses.”

Cured Creatures

The creature has Immunity to Tuberculosis for the rest of their life. Creatures may suffer permanent disabilities depending on disease severity. The following stat penalties are based on the creature’s original stats, and effects are cumulative. Greater Restoration and similar magic can completely eliminate these chronic symptoms.

• Stage 4: Permanent shortness of breath and chest pain while breathing. Max HP -1d4, max SP -5.
• Stage 5: Permanent pain and impaired function in one randomly determined body part other than the chest. Max HP -1d4, max SP -5, max Essence Points -5.
• Stage 6: Requires a mobility device such as a cane. Max HP -2d4, max SP -5, max Essence Points -10.

Relapses

Failure to fully treat Tuberculosis results in a relapse. Keep track of the number of days when treatment has been successful. Each failed or missed day of treatment will subtract days from the creature’s recovery progress.

Early Tuberculosis

During early Tuberculosis, a creature must reach 30 days of treatment. For each failed or missed day, subtract 1d4 days from the total of successful treatment days.

If the number of successful treatment days falls to 0 and the creature misses an additional day, the creature progresses to latent Tuberculosis and must restart treatment for the disease at this stage.

Latent and Active Tuberculosis

See the table of Treatment Details for the target number of treatment days at each stage. For each failed or missed day, subtract 1d8 days from the total of successful treatment days.

If the number of successful treatment days falls to 0 and the creature misses an additional day, status rolls to progress to a more serious stage of the disease resume. One status roll occurs immediately, after which status rolls continue as described under “Advancing Stages” until treatment resumes.