It itches so bad. Belly aches. I scratch but then I bleed… headaches, blurred vision… feel down and so itchy.

The Malaise is described as a virus that has been infecting the island within the Dead Cells world, and the main cause for the current state of the island and its inhabitants.

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The Malaise as a mechanic is introduced into the game at 5 Boss Stem Cells. It is a meter that has tiers that activates different effects at set tiers. Malaise can also be decreased by killing enemies, elites and bosses.

Malaise Malaise can be enabled in Normal, Hard, Very Hard, Expert and Nightmare difficulties using Custom Mode.

Malaise Malaise can be turned off using Custom Mode Malaise Disables achievements


Malaise starts building up when you break the door that seperates the start area of the actual biome in the Prisoners’ Quarters. Malaise will keep increasing alongside gametime, whenever gametime stops Malaise will stop increasing and its effects are disabled. This is in Shops, lore areas, treasure rooms, Challenge Rifts and Passages. Note that the Malaise can still be decreased in these rooms.

Increasing infection[]

Malaise has 10 tiers, each being 50 points adding up to a total of 500 points at maximum. Malaise increases constantly at a rate that correlates with the amount of enemies that are alive in the biome. On 100% enemies remaining it takes approx 42 seconds to fill up a tier.

The only other source that increases Malaise is infected food found in wall secrets.

There is a small cooldown of 0.35 seconds after an increase before it can increase again.

Points per secondEnemies remaining

Reducing infection[]

Decreasing the Malaise is mainly done by killing enemies. Each kill of an enemy decreases the Malaise meter, this includes enemies spawned by the Malaise. When you have killed enough enemies you have cleared the infection in the biome and trigger the clear infection event. This occurs when you have killed 90% of the enemies in the biome. At this point the Malaise stops increasing and the effects are disabled. Your Malaise will also decrease by the amount of points you would get from killing the last remaining enemies, but all at once. Killing them after the event does not decrease Malaise any further.

Other sources to decrease Malaise are the Health Flask and Cough Syrup bought in food shops. Health Fountains also remove all Malaise but they are normally only available in Custom Mode.

Clear infection event10% enemies
Cough Syrup150
Health Flask150
Health Fountain Malaise500
  • Note that health fountains are only available using Custom Mode as from 2 BSC all health fountains are broken and the Malaise is a 5 BSC mechanic.
    • Enable Malaise: This applies to: Normal, Hard, Very hard, Expert and Nightmare difficulties.
    • Health fountain never break Malaise


Malaise affects enemies and their behavior and stats in different ways. Some boost existing stats or ablilites while some are exclusive to Malaise.

Enemy stat boosts[]

Malaise increases the speed at which enemies move and attack as well as boosting the damage the do.

EffectDescriptionEffect levelBonusMalaise tierNotes
Strength boostIncreases the damage enemies do on the playerMalaise



• 20% Strength

• 40% Strength

• 60% Strength

• 6 – 7

• 8

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• 9 – 10

Attack delayDecreases the delay before an enemy attacksMalaise


• 1/2 of base

• 1/4 of base

• 2 – 6

• 7 – 10

Base value is unique to each enemy attack.

Enemy Teleporting[]

Enemy teleporting is a mechanic from 4 and 5 Boss Stem Cells. Malaise increases the speed at which enemies teleport and even increases the range at which an enemy can aggro another enemy to teleport to the player together.

EffectDescriptionEffect levelTeleport bonusMalaise tierNotes
Teleport chargeDecreases the charge time before an enemy teleports to the player to 0.X secondsMalaise



• 0.75 seconds

• 0.45 seconds

• 0.25 seconds

• 3 – 5

• 6 – 7

• 8 – 10

Activiting Malaise in lower BSC does not have teleporting enemies because that mechanic is a 4BSC and up exclusive not tied to Malaise.
Alert enemyIncreases the range at which enemies can alert each other to teleport together to the playerMalaise


• 5 Alert range

• 10 Alert range

• 3 – 5

• 6 – 10

Enemies spawned by the Malaise can not alert other enemies.

An enemy can alert multiple enemies if they are close enough. An enemy that has been alerted by another enemy cannot alert another enemy.

Enemy spawning[]

Malaise will spawn random enemies around the player, appearing to crawl out of the ground. The enemies that are able to spawn are not limited to the current biome.

EffectDescriptionEffect levelSpawn cooldownMalaise tierNotes
Enemy spawnDecreases the cooldown of enemies spawning around youMalaise



• Between 11 and 15 seconds

• Between 8 and 13 seconds

• Between 7 and 11

• 2 – 3

• 4 – 6

• 7 – 10

The first platform in range of the player in a combat room will generate a mob rising from the floor. The enemies that can spawn are not limited to the enemies that are in the biome but there are some that cannot be spawned by Malaise. Enemies that are spawned by other enemies or the environment do not spawn from Malaise.

Malaise spawned enemies have some restrictions over normal enemies:

  • Do not drop blueprints as these are assigned to enemies during level generation. It can be forced using the Hunter’s Grenade.
  • They can’t transform into elites.
  • They aren’t masked by Maskers.
  • They aren’t protected by Protectors and Defenders.
Below is a list of all enemies that cannot spawn through the Malaise.

Enemies that cannot spawn that are from the base game:

Malaise BatMalaise KamikazeMalaise SpawnerMalaise MaskerMalaise ShockerMalaise HammerMalaise Corpulent ZombieMalaise Living BarrelMalaise GolemMalaise DemonMalaise Guardian KnightMalaise Royal GuardMalaise BombardierMalaise ProtectorMalaise SweeperMalaise BuzzcutterMalaise Corpse FlyMalaise Sewer FlyMalaise Festering ZombieMalaise Corpse WormMalaise Weaver WormMalaise ImpalerMalaise Sewer’s TentacleMalaise CatcherMalaise Pirate CaptainMalaise SlasherMalaise ThornyMalaise Corpse JuiceMalaise CasterMalaise CannibalMalaise SlammerMalaise RampagerMalaise Failed ExperimentMalaise Oven KnightMalaise Toxic Miasma

Enemies from DLC content cannot be spawned by Malaise.

Elite transformation[]

Malaise makes it so enemies can transform into elites. When an enemy is going to transform it is stunned and charges the tranformation for 4 seconds. Transformed elites do not have random abilities.

EffectDescriptionEffect levelTransformation cooldownMalaise tierNotes
Elite transformationDecreases the cooldown of enemies tranforming into elitesMalaise


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• Between 130 and 190 seconds

• Between 90 and 130 seconds

• Between 60 and 90 seconds

• 3 – 5

• 6 – 7

• 8 – 10

The first enemy (that can be an elite) that enters the range of the player is the one that will transform.

There is a 15 second grace period in which enemies can’t transform into an elite after an elite enemy has attacked the player.

Effect by Malaise tier[]

Removed effects[]

EffectDescriptionEffect levelBonusMalaise tierNotes
Speed boostIncreases the speed at which enemies moveMalaise



• 10% Speed

• 30% Speed

• 50% Speed

• 3 – 5

• 6 – 7

• 8 – 10



The Malaise has no clear origin. During the Alchemist’s search for a cure, he theorized about where it came from. One such theory raised the possibility that the sap from the Slumbering Sanctuary contaminated the sewers within the prison[1], marking the start of the spread. The Alchemist also notes that the island’s insects likely helped spread the virus.[2] Additionally, piles of infected bodies were dumped into the sewer, and the infection appeared to rampage from there, although the Beheaded is unsure if they were dumped before or after the epidemic started.[3]


The Malaise’s symptoms include vomiting blood, itchiness, headaches, blurry vision, bellyaches, and feeling down[4]. Left untreated, the Malaise leads to certain death. It also appears to be highly infectious, with the King imprisoning and quarantining affected individuals.

The more extreme effects of the Malaise are highly unsettling. Mutations begin, and sometimes the corpses begin moving on their own.[5][6] The end result of the final stages of infection is reanimation into hostile, mutated undead.[7]

The virus affects humans and animals. Conjunctivius was a result of the mutations, and the Concierge was a victim of the virus as well. Meanwhile, the Beheaded’s true entity is immune to the Malaise and only the bodies it possessed are vulnerable.


Later into his research, the Alchemist found a way to reduce symptoms from infection,[8] as well as a method for slowing down mutations.[9] This was likely synthesized with the sap found within the Slumbering Sanctuary, which he suspected could provide the cure.

It appears that the Time Keeper had successfully kept the Malaise at bay via time manipulation,[10] but it seems that this is exhausting to her, and the Alchemist suspects that time will not contain it forever.[11]


The following information contains spoilers regarding the true ending of the game. Discretion is advised.

However, there is one character who was able to find a cure to the Malaise, which is the Collector. In the Astrolab, the Beheaded finds many more failed experiments by the Alchemist to cure the Malaise. Once he reaches the Observatory, the Collector reveals his last ditch effort to create a cure, heavily implying that he is the Alchemist, and uses the cells the Beheaded collected throughout the whole island to create the Panacea, a cure for all diseases. When he drinks it, the Collector is driven mad with power, forcing the Beheaded to fight and eventually kill him. It was at this moment did he realise that the cure was indeed effective, though he doomed the island, which was almost entirely destroyed, as he killed the only entity able to recreate it. Ultimately, as the only copy was destroyed, all treatments of the Malaise ended in failure.

Impact on the island[]

There is little sign of what the Island was like before the Malaise debuted, although it must have been at least somewhat prosperous. However, any chance at a good future on the Island was ruined by the Malaise and the King’s response to it. The island’s citizens faced civil unrest and focused their rage on the King, due to his cruel reaction to the appearance of the Malaise.[12] The King demanded that the infected were to be imprisoned and hanged, even just upon the suspicion of infection. [13] Eventually, he demanded that nobody was to be let out of the prisons, even if they served their time. [14] What little of the villagers who remained on the Island met their deaths at the hand of the Malaise and the undead, or were slowly awaiting it locked away within the prisons.


  • The Malaise was referred to as the Infection before v1.0.
  • Malaise was completely reworked in v2.1. Previously, Malaise would accumulate when you took damage, and caps your health at 10% at full stacks. Only potions, non-infected foods, Cough Syrups, and Necromancy could remove Malaise, and some mutations granted temporary immunity to it.
  • In earlier versions of the game, each point added to the Malaise gauge would increase the damage taken rather than cap health at 10% of the max when 10 points were reached.
  • According to a certain lore room, the Malaise has also been given other names, such as the Plague, the Gloom, the Infection, and the Green Poison[15]


  • The Malaise could have possibly been influenced by the Black Death.
  • Bupleurum is directly referenced as a way to minimize the symptom of the Malaise.


  • 0.7: Introduced.
  • 2.1: Reworked the Malaise.
    • Is now a time based mechanic that increases as time goes on.
    • Eating uninfected food does not decrease the Malaise.
    • Being hit doesn’t increase the Malaise. Killing enemies, Elite, and Bosses decreases the Malaise gauge.
    • Killing enough enemies (90% of enemies in the level) results in event “Malaise Cleared”.
      • Lowers the Malaise gauge by the amount one would get by killing all remaining enemies.
  • 2.3:
    • The Malaise is now exclusive to 5 BSC.
    • Enemy speed buff effect has been removed.


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