At third level, Paladins gain the feature Divine Health:

By 3rd level, the divine magic flowing through you makes you immune to disease. (PHB, p. 85)

There's a monster in Volo's Guide to Monsters called the Spawn of Kyuss which can infect enemies with a burrowing worm. If it burrows into a creature, the worm will deal necrotic damage to its target at the end of the target's turn. But there is a way to remove or neutralize the worm:

If a worm-infested creature is targeted by an effect that cures disease or removes a curse, all the worms infesting it wither away. (Volo's Guide, p. 192, bold added)

My question is whether the Paladin's "Divine Health" feature counts as the worms being "targeted by an effect that cures disease". It certainly is an effect, and it could be seen to cure disease, but I'm not sure if an "always-on" effect can be said to have "targeted" someone (my inclination is to say it can't).

Would the Paladin's Divine Health kill the worm as soon as it burrowed in? Or would the Paladin need some other method (like his/her "Lay On Hands" ability) to remove this infestation?

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    \$\begingroup\$ I'm looking at that right now to find an answer, and YEESH is it Grimdark. It's like someone from Wizards decided they wanted to port 40k Plaguebearers and Plague Zombies into 5e. \$\endgroup\$ Commented Apr 24, 2018 at 15:47
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    \$\begingroup\$ You've also inspired me to ask my own question on the Worms. Thanks. \$\endgroup\$ Commented Apr 24, 2018 at 15:56
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    \$\begingroup\$ @SeraphsWrath Spawn are a bit newer, but Sons of Kyuss have been around since the original Fiend Folio, so predate 40k. \$\endgroup\$
    – richardb
    Commented Apr 25, 2018 at 7:49
  • \$\begingroup\$ Related: What Happened to Disease in D&D5e? \$\endgroup\$
    – goodguy5
    Commented Apr 8, 2019 at 18:38

4 Answers 4


Not likely, but a case could be made for it

This is a bit of a tricky area, but in general we have go with the idea that things do what they say they do and no more. As with all things 5e, a DM can choose to view it differently, but looking at it through a RAW lens implies that the Paladin would still suffer the effects.

The case for Infestation

As I stated above, in 5e things (like spells) generally do what they say they do and no more. There is no clause in the Spawn of Kyuss that states that creatures immune to Disease are immune to the effects of the Spawn.

In addition, the Spawn of Kyuss doesn't state that it is a Disease. Just that using something that cures Disease will force them to wither away.

The case for Immunity

This piece comes from the viewpoint that much in the same way that a creature who is immune to certain conditions (like Charmed) makes them immune to spells that cause that such a condition.

There are a myriad of examples that show that being immune to a condition makes you immune to an effect (e.g., creatures immune to Frightened are not affected by a Vengeance Paladin's Abjure Enemy). Or that creatures immune to Charm are not affected by spells/abilities that Charm them.

The logic here is that if curing a disease kills the Spawn, and a paladin is immune to disease, then why would this 'disease' be active in it's body?

It's a reasonable step, but it isn't totally supported by RAW. A DM could houserule that as there is some sense to it, but I do not believe this to be RAW, however it may be intended.


(these answers, IMO, also apply to the Monk's Purity of Body)

RAW: Paladins are probably susceptible to Kyuss Worms

Because of… Reasons. 5th edition did away with a lot of verbose text present in previous editions, in favor of "plain English interpretation". With that, we get a fallout of precise text that can be pointed to with that triumphant "A HA!" that we all like.

RAI: Paladins are maybe immune to Kyuss Worms

To quote myself from just earlier,

5th edition did away with a lot of verbose text present in previous editions, in favor of "plain English interpretation"

If the ability can be removed with Remove Disease, then it probably counts as a "Disease".

So, what's a disease?

dis·ease dəˈzēz
a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.

Since we don't have a "diseased" condition in 5th edition, let's look at effects that call out disease in the Monster Manual.

  • Aboleths (mucous and tentacles)
  • Gas Spore (death burst)
  • Otyugh
  • Blue Slaad (Chaos Phage)
  • Death Dog (under it's bite, it actually says "become poisoned")
  • (Variant) Diseased Giant Rats (Bite)

And I saved this one for last: Red Slaad:

…DC 14 Constitution Saving Throw or be infected with a disease – a miniscule slaad egg…

A parasite that is inserted into the creature and will eventually kill it, is a disease.

So, that's 6-7 monsters in the MM and there are a couple references of "how to create diseases" in the DMG (p 256). Divine Health is an ability that doesn't get a ton of usage anyway and there's a precedent for an infestation of parasites to be counted as a disease…

Which brings me to:

RACS: Paladins are definitely immune to Kyuss Worms

An "always on" effect shouldn't be bypassed by a minor grammatical snafu of the word "targeting".

If a Fire Elemental was attacked by something that had text like:

"If a fire-worm-infested creature is targeted by an effect that bestows resistance or immunity to fire damage, all the fire-worms infesting it wither away.

You likely wouldn't say "Well, the Fire Elemental's Fire Immunity isn't targeting it so… I guess he still has fire worms burrowing into his fire-skin. Sucks to suck."

If you look back to 1st edition AD&D (In the Fiend Folio), the text about "Cure Disease or Remove Curse" is an ancient throwback. The only thing missing is the text about "in 1d4+1 rounds, the worm burrows into the target's brain and it dies". This is a Monster that was created, partially as fan service, but also years after the original release of the core books.

I find it unlikely that the writers of Volo's Guide looked at the old Son of Kyuss statblocks, then at the PHB Paladin, then read through both and made a deliberate decision to word the worm infestation in such a way as to exclude Divine Health (and the Monk's Purity of Body, for that matter).

RAF: Don't surprise your players

If at your table, parasites don't count as a disease, then make sure your Paladin (and everyone) knows that. It would be taking advantage of your infinite DM-powers to withhold that information as a special "GOTCHA!" so that the Paladin gets a Kyuss Worm infestation when he feels that he should be immune to it.

At MY table? Let the Paladin shine just a little bit brighter. It'd be cool to have these worms fall onto the Paladin's skin and take a bite, only to burst in a *pop* of radiance and crumble to the ground. He's a chosen warrior of the realm. It should feel like it.

RAW: Rules as Written
RAI: Rules as Intended
RACS: Rules as Common Sense
RAF: Rules as Fun

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    \$\begingroup\$ I think "Don't surprise your players" is important here, especially if they're aware that the interaction will be DM-ruled. So if you're making them resistent, have then die funnily, and if they're a risk, tell the Paladin ASAP - for example: "You see Kyuss Worms, and you realize that your divine health won't stop them from affecting you" in time for the player to respond. \$\endgroup\$
    – Gloweye
    Commented Nov 25, 2019 at 10:05


Removing the worms requires targeting a creature who is infected with an effect that cures disease. Divine Health does not have a target.

On the other hand, Lay on Hands does (emphasis mine).

Alternatively, you can expend 5 hit points from your pool of healing to cure the target of one disease or neutralize one poison affecting it.

Even though Burrowing Worm is negated by an effect that cures disease, it is not in itself a disease.

Contrast this to the Otyugh's Bite attack which states:

If the target is a creature, it must succeed on a DC 15 Constitution saving throw against disease or become poisoned until the disease is cured.

The mechanics of the Burrowing Worm do not mirror any disease from the books and the worms are also quelled by curse-removing effects (something a disease would not be affected by).


This is a biological versus mythogical debate. A virus is alive and can cause symptoms and infect, thus the disease field is full of diseases caysed by bacteria, viruses, and parasites. A tapeworm is a parasite too. I think the kyuss spawn and sons were intended to be a supernatural, aberation, extra planar, alien. Like the face hugger in the movie Alien, or the vampires in the book and tv series "The Strain". Its a parasite /host situation. An undead one too. So I would consider it a supernatural disease AND an infrstation of parasites. I would think the Paladin would be immune to dying,or transforming from the worm. But he would be a carrier. The worm could leave and infect his teammates. He wouldnt get sick, but the worm couldnt reproduce in him. It could be cut out and killed. Remove disease, remove curse, lay pn hands would kill it. Barskin of a.c.5 would prevent burrowing. Wormpaste wards it off. Siversheen on your skin might protect you too. If the worm takes 1 point of damage it dies. Its also indead so a cleric or paladin turn undead may remove or destroy it, but its weird nature may make it immune to turning. Or you could just kill a night hag and take her heartstone.

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    \$\begingroup\$ Welcome to RPG.SE! Take the tour if you haven't already. This answer seems very noncommittal and unclear... It's sort of a non-answer answer. \$\endgroup\$
    – V2Blast
    Commented Jan 1, 2019 at 16:32

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