ghoul fever Condition in Scarterra | World Anvil

ghoul fever

Ghoul fever is a terrifying disease, and it has a chance to cause a person to make someone turn into an undead, albeit a small chance.   One of the most insidious things about ghoul fever is how poorly understood it is. It is relatively easy to treat and is quite survivable, but ignorance makes disease worse than it is. Sometimes ghoul fever is underestimated as a common illness and is left untreated. Otherwise ghoul fever is recognized immediately as “ghoul fever” and the victim and his acquaintances over fixate on the “ghoul” part, and they treat the disease too aggressively, sometimes even killing the victim to prevent him from becoming undead, perhaps even with the victim asking to be killed.

Transmission & Vectors

Ghoul fever is normally contracted by being bitten by a ghoul (Stamina difficulty 9 to not be infected after this) or clawed by a ghoul (Stamina difficulty 6 to not be infected).   A dead ghoul decomposing can contaminate a water supply either accidentally or because some nefarious person dumped ghoul corpse parts into someone’s drinking water. Drinking contaminated water has variable difficulties to resist infection depending on how contaminated the water is and how much of it they drink.


Ghoul fever has a long incubation period, so it is often misdiagnosed. It tends to incubate two to four weeks. During this period, it is possible but rare for the subject to pass on ghoul fever to others through sexual contact or excreting waste products near drinking water.   On the onset of symptoms, the subject gets a sickly pallor that gradually turns into a ghoulish appearance. The subject gets random craving for undercooked meat. Subjects often find ordinarily repulsive smells pleasant and ordinarily pleasant smells repulsive.   The next symptom is fever, not really any different than any other fever. After about a week or so, a mild cough develops which gradually grows into a severe cough that frequently includes small amounts of blood. In game terms this is represented by Stamina saving throws to resist taking physical attribute damage (which heals like any other).   In the final stage, the victim is bedridden for about two weeks. The victim needs to roll Stamina difficulty 7, if he gets bedrest and care. A lower difficulty if he is getting proper medical care and a higher difficulty if he is basically “resting” in a state of filth or neglect. On a botch the victim dies and becomes a ghoul after death. On a failure the victim loses a dot of Appearance permanently and takes two points of physical attribute damage and two points of (recoverable) social attribute damage. With one success the subject takes two points of physical attribute damage and two points of social attribute damage. With two successes the subject takes one point of physical and social attribute damage and with three successes the victim emerges relatively unscathed.


Early stage ghoul fever can be cured with Purification ●●● and late stage ghoul fever can be cured with Purification ●●●●.   Ghoul fever can be survived by all but the most unlucky with weeks of bed rest and adequate food and water (and someone to change the sheets often). Very knowledgeable herbalists can produce remedies to reduce pain and discomfort and make survival even more likely.   Ghoul fever is not widely understood. Some treatments, unfortunately are too aggressive. Given that there is a chance, albeit a small one, of the victim rising as an undead ghoul later, this incentivizes both the victim and those around her to taking extreme measures, sometimes including euthanizing the victim before she "turns."


Left untreated, ghoul fever has roughly a 40% survival rate and a 20% chance of the dead victim rising again as a ghoul.   With proper treatment, ghoul fever has roughly a 80% survival rate and a 10% chance of the dead victim rising again as a ghoul.   Purification magic has a 100% success, if the victim can find someone with high enough proficiency in Purification magic, dabblers need not apply.   Survivors of ghoul fever often bear life long disfigurements of some sort though few if any other lasting effects. Proper medical treatment reduces the likelihood and severity of these scars.


The main preventative measure to take is to not be bitten by a ghoul. Easier than it sounds as ghouls are fairly rare.   Purification ●● magic (or simple boiling) can cleanse water contaminated with ghoul fever.

Cover image: by me with Midjourney


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