RimWorld Disease Handbook: Every Illness and How to Treat It

A sick colonist is a productivity sinkhole and a possible body bag, depending on how fast you react. RimWorld throws a wide catalog of illnesses at your settlement, from a mild flu to organ-melting horrors that ignore your best doctors. Knowing what each disease does, how quickly it kills, and which treatment actually works is the difference between a stable colony and a graveyard with a research bench next to it.

Before getting into the list, remember that your AI storyteller controls how often disease events appear. If you want a calmer playthrough, tweak the storyteller settings or use the dev console to disable specific illnesses. Once an outbreak begins, response time matters more than research.

Fast killers: react now or lose them

These diseases punish hesitation. Anything in this group can finish an untreated colonist within a day or two.

Infection

Infection is the speedrun champion of RimWorld deaths. After a wound goes untreated (or gets patched up with dirty hands in a filthy hospital), infection sets in and can kill a colonist in under 1.5 in-game days.

Treatment: Bed rest plus regular medicine. If the infection is winning, amputating the affected limb instantly drops the rate to zero. Brutal, but a one-legged pawn beats a buried one.

Plague

Plague is a faster, nastier version of the flu. It hits both humans and animals, can rip through a colony quickly, and kills within roughly 1.5 days if you ignore it. Expect pain, impaired consciousness, and reduced manipulation.

Treatment: Bed rest and medicine, applied early. Stockpile herbal medicine before plague season if your map is prone to it.

Common infections: manageable with proper care

Flu

The most familiar entry on this list. Symptoms include reduced breathing, manipulation, and consciousness, with vomiting in later stages. Most colonists shrug it off with rest, but neglect can still get someone killed.

Treatment: Bed rest and medicine.

Malaria

More dangerous than the flu. Malaria first impairs consciousness and blood filtration, then escalates into pain, vomiting, and reduced motor control. Untreated cases can end in death.

Treatment: Bed rest plus medicine. You can also feed Penoxycyline to healthy colonists as a preventive, although it will not stop an infection already underway.

Sleeping Sickness

A slow burn picked up almost exclusively from tropical biomes such as rainforests and swamps. Caravans passing through these regions are more vulnerable than colonists sitting at home. Symptoms include impaired consciousness, reduced manipulation, and pain, with vomiting late on. It takes about 20 in-game days to become lethal.

Treatment: Bed rest and medicine.

Infant Illness

Tied to the Biotech DLC, Infant Illness only affects babies born sick. Early stages bring pain and vomiting. Severe stages add reduced breathing and consciousness, and a baby that runs out of time will die.

Treatment: Bed rest and medicine.

Parasites and rot: persistent, rarely fatal

Lung Rot

Lung Rot creeps in when colonists spend too much time around rot stink. Symptoms include pain and reduced breathing, with consciousness damage in the late extreme stage. The patient does not need to be confined to bed.

Treatment: Regular medicine doses. The disease clears itself after 6 to 8 in-game days.

Gut Worms

Charming parasites that turn a colonist's digestive tract into a buffet. The patient suffers pain, vomits, and gains a 100% hunger boost. Expect your food stockpile to take a hit.

Treatment: A doctor tending the patient resolves Gut Worms in about 48 in-game hours. You can also fast-track recovery with Healer Mech Serum, a stomach replacement, or a Biosculptor Pod medic cycle.

Muscle Parasites

Muscle Parasites will not kill anyone, but they tank your work output. The patient deals with impaired manipulation and movement, pain, and a 100% sleep fall rate.

Treatment: Doctor tending plus medicine clears it in roughly 48 in-game hours.

Mechanites: positive effects with a catch

Fibrous Mechanites

A genuinely unusual disease. Fibrous Mechanites boost manipulation, mobility, and blood flow, turning the colonist into a temporary super-worker. The price is faster sleep loss and significant pain.

Treatment: There is no proper cure. The mechanites flush themselves out within 48 in-game hours. Medicine can slow progression but will not end the disease.

Sensory Mechanites

The sibling buff. Sensory Mechanites improve sight, hearing, manipulation, and talking, in exchange for sharp pain and accelerated sleep fall.

Treatment: Same as Fibrous. Wait it out, optionally slow it with medicine.

Animal-only

Scaria

Scaria only affects animals, and it permanently converts the infected creature into a manhunter that attacks anything humanoid or mechanoid in sight. Untreated, the animal dies after five in-game days.

Treatment: Down (not kill) the animal first, then operate. Surgery requires at least 3x industrial-grade medicine or better, plus a doctor with Medical skill 8 or higher. A reasonable price for keeping a beloved alphabeaver alive.

Long-haul and DLC content

Blood Rot

A slow, ugly disease pulled from the Royalty DLC quest pool. Blood Rot reduces blood flow and filtration. In its extreme stage, expect pain and vomiting. Without treatment, it can be fatal.

Treatment: Steady medicine doses resolve it after 30 to 40 in-game days. A high-skill doctor can also operate on the patient for an immediate fix.

Paralytic Abasia

Another Royalty DLC visitor. Paralytic Abasia paralyzes the patient into a Downed state and rarely self-resolves.

Treatment: A doctor with Medical skill 5 or higher applies 10x Glitterworld Medicine. Alternatives include Healer Mech Serum or the Unnatural Healing ability.

Organ Decay

The rare, untreatable nightmare. The patient suffers escalating pain and reduced body part efficiency. After 30 to 40 in-game days, the affected organ shuts down entirely.

Treatment: No medicine helps. Replace the dead body part with bionics or prosthetics and move on.

Prevention notes

Keeping a clean hospital, hauling rotting corpses out quickly, and stockpiling medicine before disease events go a long way. Train at least two pawns in medicine so a single bad raid does not leave you without a doctor. A bit of preparation is far cheaper than a row of fresh graves.