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This entry contains potential spoilers for Pathologic 2. Read at your own risk.

This entry includes information regarding both Pathologic (2005) and Pathologic 2 (2019).

Manifestation of the Sand Plague

Allow me to remind you that an epidemic of unknown origin has already eradicated a few genuinely distinctive towns in the northern part of the country. The cause and circumstances of these tragic events remain uncertain. There is a lot that we cannot explain yet.

It appears as though the plague has a mind of its own, as if it is driven by some irrepressible will. Why else has no one managed to fight it successfully? Why does it target the most precious aspects of our existence? The Sand Plague picks its victims fastidiously—and the same principle always draws it back to whoever tries to oppose it.

Surprisingly, we've yet to hear a single word from the Powers That Be.
[from H. Orff's internal note]

The Plague is the main obstacle the Healers must contend with during the events of Pathologic. It is a disease of seemingly unknown origin that kills whoever contracts it. It has also been called Sand Plague, Sand Filth, Sand Ulcers, Sand Fever, Sand Pest, Sand Dirt, and Sandy. It is heavily implied that the Plague is sentient, which would explain the total powerlessness of science in the struggle against it.



The First Outbreak

Five years before the events of the game, the first outbreak of Sand Fever occurred.

It broke out in the Crude Sprawl and it was possible to localize; thanks to the unusual layout of the city, the district was boarded up quickly and the infection did not spread. Isidor Burakh and his students were able to suppress the outbreak and avoid infection by drinking experimental twyrine extracts.

Although many townsfolk speak highly about Isidor for his work, Isidor did not take praise for his role in that victory. According to Vlad the Younger, he did not like to talk about it and attributed the suppression of the Plague only to happy coincidence.

Some time before the outbreak of the epidemic, children invented "shmowders" as part of a game. These rudimentary cures are highly dangerous, but one of the only cures to the disease.

Aspity appeared during the first outbreak. According to her, she came from the Steppe "as a reminder." She inhabits a house on the outskirts of the Crude Sprawl, where the previous outbreak began.

Citizens remember the first outbreak with horror, and when they learn that the disease came back, do not believe in salvation. Some townsfolk, such as Willow Mellow and later Anna Angel, take to stockpiling pills and other precautions.

The Second Outbreak

The second outbreak began in the Skinners, despite the efforts of Isidor to prevent it. As it spreads through the town, the work of the Bachelor, Haruspex, and Changeling reveals its origins. The Plague is tied to the earth, and researching its origins reveals the origins of the town and the impact of the Polyhedron upon it. Blood poured underground has collected over several centuries, and with the building of the Polyhedron the Plague was first unleashed. Whether the blood or the Polyhedron is responsible is unclear, as each healer makes their own conclusions. The Bachelor's observations confirm that the Plague is bacterial in origin, which is agreed upon by everyone.

Pathologic 2

The First Outbreak

Five years ago, the first outbreak began in the Crude Sprawl. Isidor Burakh ordered the district boarded up, and it was allowed to infect the Crude Sprawl. There were no survivors. Murky's parents were two of the victims of this outbreak. Regardless of the loss of life, many people see Isidor as doing what was necessary to keep the town alive.

Following the first outbreak, Aspity appeared and began to live in the Crude Sprawl. Her Reflection speaks as if Isidor was responsible for her creation, and she feels as if she owes her life to him.

The Second Outbreak

The second outbreak spreads from Isidor Burakh's House in the Hindquarters, and also spreads to its sister districts the Skinners and Tanners on the same day. The Haruspex works to find the source of the Plague and an appropriate Panacea. The Plague also appears to the Haruspex in the form of an Executor on several occasions. It taunts the Haruspex in his attempt to find the cure and refutes any comments that paint it in a negative light, seeing itself as a catalyst for development and a gift worth preserving.

Eventually, the Haruspex discovers that Isidor was the original carrier of the Plague, and that Isidor and Simon Kain made the choice to purposely reintroduce the disease. The Plague itself is a manifestation of the Earth's pain from the damage wrought by the Polyhedron's construction. Albinos refer to it as the Earth's Medrel, or nerves. During the trip to Olonngo, the Haruspex learns that the disease only impacts humans, and is a threat only to those it considers separate from the Earth.

The Haruspex can choose to destroy the Polyhedron, removing it from the wound it has left in the earth and allowing Living Blood to flow. He can also choose to save it, allowing miracles of the Living Earth, including the Plague, to flourish.

Voice of the Plague

See Plague/Spoken Dialogue.

In Pathologic 2 the Plague is able to speak directly to its victims. In the case of arsonists it coerces them that burning the infected is kinder than allowing them to suffer. [1]

Should the Haruspex become infected he will be able to hear the voice of the Plague.



All routes

On Day 3, infected districts are introduced. Infected districts are murkier, with bloody rags littered on the ground and unusual red lichen growing on house walls. Infected houses can be looted without consequence to reputation or aggression from its inhabitants. Plague clouds will be located at points throughout an infected district, as well as chasing the player through infected districts and homes. Rats will also chase the player and can transmit infection. Avoiding infection via plague clouds and vermin can be done through use of immunity boosters and protective clothing.

Guards are posted at district entrances. They will attack infected people who attempt to leave the district. Infected people wrapped in rags will wander the district and attempt to attack the player. Others in the early stages of infection will be curled up on the streets or inside houses. They can be given painkillers in exchange for a reputation boost. The Skinners is infected today.

On Day 4, burned districts are introduced. These districts are roamed by muggers day and night, with looters within the houses. Houses can again be looted without consequence. Patrolmen posted at the entrances to these districts will attack muggers. The Tanners and the Works are infected today. The Skinners district is burned.

On Day 5, Plague Angels begin to follow the player through infected districts. Arsonists referred to as Exterminators begin to appear in infected districts. They will attack the wandering infected people using Combustible Fluid. Guards will attack them. The Hindquarters, the Gut, and the Warehouses are infected today. The Tanners and the Works are burned.

On Day 6, the Atrium is infected. The Hindquarters, the Gut, and the Warehouses are burned.

On Day 7, the Skinners, the Spleen, and the Backbone are infected. The Atrium is burned.

On Day 8, the Gut, the Crude Sprawl, and the Tanners are infected. The Skinners, the Spleen, and the Backbone are burned.

On Day 9, the Army replaces the town guards posted around infected and burned districts. These include soldiers with rifles, as well as flamethrower units. Soldiers wielding flamethrowers will also attack rats. The Maw, the Chine, and the Hindquarters are infected today. The Gut, the Crude Sprawl, and the Tanners are burned.

On Day 10, the Bridge Square, the Tanners, and the Works are infected. The Maw, the Chine, and the Hindquarters are burned.

On Day 11, the Backbone is infected. The Bridge Square, the Tanners, and the Works are burned.

Bachelor Route

On Day 1, the Bachelor discovers that the Plague is responsible for the death of Simon Kain. He begins taking action to combat the outbreak with the help of Rubin.

On Day 2, sees the Bachelor find up to two more vectors of infection, located in the Silent House and a potential site for Lara's House of the Living.

On Day 3, the Bachelor and Rubin begin to study the disease in earnest.

On Day 4, the Bachelor sets up the Theatre as a hospital and the Cathedral as a quarantine ward to help fight the plague. The first version of the vaccine is produced by Rubin to help combat the Plague.

On Day 5, the Bachelor and Rubin make further progress with the vaccine, with the help of Artemy Burakh.

On Day 6, it is revealed the quarantine in the Cathedral was broken overnight. The Bachelor spends his day trying to find a carrier of the Plague.

On Day 8, the Bachelor and the Inquisitor begin to look into the source of the Plague. Their investigations lead them to the Abattoir and underground.

Haruspex Route

On Day 1, the Haruspex meets the Bachelor, who has been investigating the deaths of Simon Kain and Isidor Burakh. He learns that the Bachelor believes these men to have been killed by a Plague.

On Day 3, the Haruspex receives the first of six daily letters which contain extracts from his father's diary. These letters discuss the actions taken by Isidor and his apprentices during the first outbreak, as well as the build up to the second outbreak. The Haruspex can also trade twyrine extracts to Notkin for the ability to buy maps of Plague-stricken districts. The Bachelor will start his research in earnest, and request infected tissue samples from the Haruspex in exchange for his choice of medication.

On Day 5, the Haruspex acquires an infected heart to provide to the Bachelor in their efforts to understand the disease and find an ingredient source for a Panacea. It is revealed that antibodies cannot be extracted from the blood.

Following the line of questioning opened on the previous day, Day 6 finds the Haruspex introducing the infection to bulls, who are yet to be impacted by the Plague. After acquiring Bull's Blood, the Bachelor confirms that while human antibodies destroy the bacteria, bull antibodies prevent the prolific bacteria from reproducing. A chimera with both of these features would be needed to effectively combat the Plague in a cure.

On Day 7, the Haruspex receives a vial of blood from the abattoir from Foreman Oyun. This allows production of the first vial of Panacea. This is the only known cure for the plague other than the mysterious shmowders.

Changeling Route

On Day 2, the Changeling is asked to investigate Aspity. The governor, Alexander Saburov believes the mysterious woman is responsible for the Plague. Further investigation reveals that this is not the case, though Aspity was spawned from the earth after the first outbreak.

On Day 3, the Changeling uncovers the secrets of Anna Angel, who took the form of Willow Mellow. Willow had been stockpiling medicine, and the first outbreak occurred shortly after. However, Anna did not cause the plague.

On Day 4, the Changeling is sent to investigate Bad Grief, who Saburov accuses of throwing corpses in the river. However, he ultimately turns out to be innocent of any role in the epidemic.

On Day 5, the Changeling breaks quarantine in the Cathedral. She finds the people inside are healthy. She also investigates the involvement of Stanislav Rubin in the outbreak and the death of Isidor Burakh.

On Day 6, the Changeling must prove that she is not the cause of the infection in the Cathedral. She locates the Bachelor to take a sample of her blood. She also begins to receive daily dreams and letters about her twin, who accompanies the Plague to infected districts and can permanently infect them if left alone. This continues until Day 12, after four hours or more of sleep.

Pathologic 2

Haruspex Route

Infected and Burned Districts

On Day 3, the Tanners, Skinners, and Hindquarters districts will be infected. Peter Stamatin and Anna Angel will be under threat of infection. Despite Georgiy Kain's concern, Andrey Stamatin is not at risk of becoming infected.

On Day 4, the Factory, Warehouse, Gut, and the Chine will be infected. Sticky, Andrey Stamatin, Bad Grief, Capella, Big Vlad, and Yulia Lyuricheva will be under threat of infection. The Tanners, Skinners, and Hindquarters districts are burned today. The Crude Sprawl will be infected and Aspity will be under threat of infection if the Haruspex did not complete the 'House of Death' quest on Day 3.

On Day 5, the Marrow, Maw, and Spleen districts will be infected. Vlad the Younger, and Khan will be under threat of infection. The Flank district will be infected and Lara will be under threat of infection if the Haruspex gave her a water barrel on Day 4. The Factory, Warehouse, Gut, and Chine districts will be burned, while the Crude Sprawl will only be burned if the 'House of Death' was not completed. Fire-starters start to appear in infected districts, setting infected people (including the player, if they are so) on fire.

On Day 6, the Atrium, Tanners, and Skinners districts will be infected. Peter Stamatin, Alexander Saburov, and Katerina Saburova will be under threat of infection. The Marrow, Maw, and Spleen will be burned. If the Haruspex did not deal with the Chemist on Day 5, the Bridge Square will be infected and Eva Yan, Maria Kaina, Georgiy Kain, and Victor Kain will be under threat of infection. If Lara's water quest was completed by delivering her a barrel of water, the Flank district will be burned.

On Day 7, the Factory, Backbone, Flank, Warehouses, and the Crude Sprawl districts will be infected. Aspity, Sticky, Andrey Stamatin, Notkin, Bad Grief and Lara Ravel will be in danger. The Atrium, Tanners, and Skinners districts will be burned. Regardless of whether the Haruspex dealt with the Chemist on Day 5, the Bridge Square will not be burned.

On Day 8, the Chine, Marrow, Gut, and Maw districts will be infected. Capella, Big Vlad, Yulia Lyuricheva, and Vlad the Younger will be in danger. The Factory, Backbone, Flank, Warehouses, Crude Sprawl, and Atrium (second day in a row) districts will be burned.

On Day 9, the Bridge Square, Spleen, Warehouses, Flank, Hindquarters, and Crude Sprawl districts will be infected. Aspity, Anna Angel, Notkin, Bad Grief, Khan, Lara Ravel, Eva Yan, Victor Kain, Maria Kain, and Georgiy Kain will be in danger. The Chine, Marrow, Gut, Maw, and Atrium (third day in a row) districts will be burned.

On Day 10, the Maw, Backbone, Chine, Tanners, Skinners, Factory, and Hindquarters (second day in a row) districts will be infected. Peter Stamatin, Anna Angel, Andrey Stamatin, Yulia Lyuricheva, Alexander Saburov, Katerina Saburova, Big Vlad and Vlad the Younger will be in danger. The Bridge Square, Spleen, Warehouses, Flank, and Crude Sprawl districts will be burned.

On Day 11, The Atrium, Flank, Marrow, Spleen, Crude Sprawl, and Hindquarters (third day in a row) districts will be infected. The Maw, Backbone, Chine, Tanners, and Skinners districts will be burned. Despite being infected the day prior, the Factory district will not be burned.

Act 2

On Day 2, the Haruspex releases the Plague into the Town with the unlocking of Isidor Burakh's House. The Plague is first encountered as a cloud of black particles. It seeps across the Skinners, creating reddened boils along the nearby houses that are noted to resemble mold or lentigines. Many townsfolk believe that the particles of the disease are excess soot from the Factory.

On Day 3, the epidemic officially begins with warning bells ringing across the Town. The Haruspex will then be told of the Fund set up to aid the doctors of the Town in fighting the disease. He will also be told that there plans for a hospital to be set up in the Theatre. On this day, the Tanners, Skinners, and Hindquarters districts will be infected. Peter Stamatin and Anna Angel are under threat of becoming infected. They can be given any type of immunity boosting medicine or Twyrine to improve their chances of escaping infection. The Haruspex can also consume these to protect his own immunity. There is a house in the Crude Sprawl where infection already lurks and should the Haruspex stay the night, or light candles within the home before midnight, the district will be protected the next day. At midnight, all Bound in danger will roll for infection. This will happen every subsequent night.

Act 3

As early as Day 4 and as late as Day 6, the Haruspex can make antibiotics from infected organs to fight the infection. These can lead to the Haruspex finding the solution to his Panacea. As the treatments are made, the Executor masquerading as the Plague will continue to mock his efforts.

On Day 4, Notkin becomes infected. If he is not healed with a Shmowder, he is at high risk of dying at midnight. He, and any other infected person, can be treated with antibiotics when no cures are available, boosting their chances of surviving each day. An Executor will show the Haruspex a gruesome hallucination of the Termites hanging from the ceiling of the Haruspex's Lair on his first time re-entering the building after 07:30. The same Executor will be waiting outside of the Soul-and-a-Half Fortress, ready to mock the Haruspex after he visits Notkin, promising that they will kill everyone on his List eventually - including the Eighth. This Executor is a manifestation of the Plague.

The hospital opens on Day 4 and the duty is to relieve the pain of a number of plague victims. Lara Ravel wishes to open a Shelter for the needy in the Town and requires a water barrel. She asks the Haruspex to collect one as they are now under guard. Completing this request can lead to the Flank becoming infected the next day, or the removal of several infected - and clean - water barrels. Water pumps in previously infected districts will be broken, and barrels will at times run dry. Starting today, Dora Feugel and Marat Ranin will be present at the Town Hall to offer rewards for rescuing babies from infected districts. Today's baby will be in the Chine, should Anna Angel not be infected.

On Day 5, the Changeling will ask the Haruspex to go to the Rod. Upon arriving he will discover a mob standing by Alexander Saburov's front door. They claim that not everyone who contracts the Sand Plague dies. Meanwhile Murky will detail that she has made a friend who dislikes the Haruspex. Sticky will tell the Haruspex that he has been asked by a Chemist in the Atrium to embalm corpses. The Haruspex then has the option to remove corpses from homes in the district after speaking to the Chemist and Victor Kain. Leaving the chemist alone exposes the Bridge Square residents to the Plague the next day. The hospital duty for this day is treating patients with antibiotics. In the evening, a bull will be sacrificed at the Ragi Barrow and should the Haruspex aid the Kin in the ritual, he will receive a bottle of Bull Blood that can be given to the Bachelor for testing. Today's baby will be in the Maw, should Anna Angel not be infected.

On Day 6, the hospital duty is to collect organs, both infected and healthy. The Haruspex is able to meet Murky's friend at the Crowstone, who appears as the Changeling. The Changeling asks if he would like to be able to speak to Murky's friend directly. If he agrees to the deal, he will become infected. If he refuses, Murky will die. Today's baby will be in the Atrium, should Anna Angel not be infected and if the Haruspex has not already found two babies.

Act 4

On Day 7, the Termitary is opened and it is discovered that a significant number of the residents have died from the Sand Plague. The hospital duty for this day is returning living infected individuals that have been incorrectly marked as dead to the Theatre.

On Day 8, the hospital duty is overseeing the Theatre for an hour until new Orderlies arrive for their shift. The orderlies are late and the Haruspex must stay inside the infected building for one hour and fifteen minutes instead.

On Day 9, the Haruspex will be allowed to enter the Abattoir. While inside, he will be able to collect a limited number of vials of blood for his panacea. As he makes his way through the Abattoir, he will see Herb Brides dancing with the Plague as they are immune to its effects. Once the Haruspex reaches the main chamber, he will be told to jump into the pit in the middle. Below the Earth, he will find a living heart with the point of the Polyhedron mere metres away from piercing it. It is here he will discover that it was the Polyhedron that caused the Plague, as the disease is the manifestation of the Earth's pain.

The Plague will appear again as an Executor on this day or Day 10, threatening to take all of the children on the Haruspex's list at once. The hospital duty for Day 9 is completely curing an infected patient on behalf of the Changeling. The children of the town will largely be gathered on the Polyhedron steps, including most of the Haruspex's list, as it serves as an isolation ward.

On Day 10, all of the children on the Haruspex's list will become infected. If any of the children were already infected, they will instead roll for death. There is no more hospital duty as the hospital has been shut down with no one left to save.

On Day 11, the Haruspex is able to choose how he would like to end the epidemic. He is able to destroy the Polyhedron and rip the spike from the ground, allowing enough living blood to emerge to make panacea to save the rest of the Town, and destroying the Plague and the Earth in the process. This will lead to the Diurnal ending on Day 12. He may also choose to allow the Plague to continue, retaining the Earth and its miracles, but many townspeople will be forced to leave. This will lead to the Nocturnal ending on Day 12.



Plague Clouds

Plague clouds are gaseous grey masses that appear in infected districts. They often appear to contain screaming faces. Some plague clouds are stationary, positioned at choke points and in common walkways of the infected districts. Others will chase the player in a straight line through districts. They can be viewed through the Plaguefinder. The clouds can also be found in infected houses, where they are more mobile and will follow the player.

Unless the player's immunity or protection is high, walking through a plague cloud will cause infection.

Plague Angels

Plague "angels" are red apparitions, similar to clouds, that resemble the embrace of an infected person if allowed to approach. They will chase the player through infected districts, though they may stop if the player does. These apparitions will not be found indoors.

Pathologic 2

Infected air

The air in infected districts contains black flakes, and is considered by the townsfolk to resemble soot or a miasma. This air causes a constant tick down of immunity that persists throughout a district, only stopping indoors.

Plague Clouds

Plague clouds are masses of the black flakes found in infected districts, closely grouped together. Their stationary form can be found at choke points around town or indoors, such as gates and stairways. They can also be found moving around indoors and outdoors along set paths, such as corridors or roads. Stationary clouds can be dispersed using the lantern, if the player has a match.

Plague clouds can also be hidden inside drawers or corpses, and will disperse when opened. They will also occasionally spawn and chase the player.

Being hit by a plague cloud causes a rapid decrease in the player's immunity.

Murky's Friend

An executor appears to the Haruspex on returning to the Lair on Day 4, after visiting Notkin the same day, following his creation of the first antibiotics from infected organs, when brewing the first Panacea, and upon waking from sleep taken any time after 07:30 on Day 9. It is initially referred to as ???. Following Murky's quest on Day 6, it is named.

This aspect of the Plague cannot hurt the Haruspex directly, but instead taunts him and the player. It also offers a unique insight into the workings of the Plague, supporting the argument that it is a sentient being.

Death's Face

During the 'House of Death' quest, an apparition of a skull-like face appears on the walls of the house. The Haruspex can light candles to chase it away. Death's Face will damage immunity if not combated successfully. By looking at Death's Face it can be halted momentarily, allowing the Haruspex to move through the house.

Pathologic: The Marble Nest

Birdies, birdies... gather ye here, round the marble nest...

This entry contains potential spoilers for Pathologic 2: The Marble Nest. Read at your own risk.

The Executor

The Executor appears at the beginning of Pathologic: The Marble Nest, and reappears on the conclusion of every subsequent day. This beakhead attempts to encourage the Bachelor to accept death. Should the Bachelor die within the Marble Nest, the Executor will admonish him for dying improperly and force the player to return to their last save point.

Plague Clouds

As in Pathologic 2, clouds are present in Pathologic: The Marble Nest. They appear in the evening.

Death's Face

Death's face also makes an appearance in one of the Bridge Square houses. The Bachelor is given advice on how to counteract the Face, and to defeat it. Upon hearing the sound that indicates it is nearby, facing the Face can freeze it for a short time, allowing the player to move past it. The Face will follow the player through the house, appearing on the walls of each room. To escape entirely from the face requires finding a key to enter a locked room within the house, finding 'himself' within the room.


Official Art


  • In Pathologic: The Marble Nest, the soldiers refer to infected individuals who irrresponsibly hide from quarantine "Wicks", and refer to those who appropriately handle the disease by covering themselves in bandages and adhere to quarantine as called "Mites"; taken from "dynamite".
  • In Pathologic 2, the Plague is voiced by Irina Kireeva in Russian. In English, it has two voice actors: Adam Wakeling and Jessica McIntyre.


  1. "Everyone wants to play as a firestarter! It's boring to be sick. Folks say the firestarters are sick, too. The plague doesn't kill them; it whispers to them, tells them to burn folks so they suffer less. It's kind."