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Sinus Infection is a passive item added in Afterbirth †.
- Grants a chance to fire a booger which sticks to an enemy and poisons it.
- Multiple boogers can stick to one enemy to deal extra damage.
- The booger tears deal their damage once per second.
- Each tick of poison deals damage equal to Isaac's tear damage.
- The booger lasts for 60 seconds or until the enemy dies.
- Boogers cannot pierce, and stick to the first enemy that they come in contact with.
- The booger falls off the enemy after they die. If it hits another enemy before it touches the ground, it will stick to them and deal damage.
- Jumping enemies or bosses like Monstro and Leapers and burrowing enemies like Round Worms and Lumps can get rid of the booger when they leap or burrow.
- Bosses like The Harbingers or Dark One, or enemies like Oob that have dash attacks do not lose the booger when they go off-screen.
- The tear sticking effect is similar to Explosivo's.
- Booger shots cannot impact bombs, making it potentially difficult to evade hostile bombs or push your own bombs along.
- Booger shots also cannot impact fireplaces.
- Booger shots don't deal direct damage, and only deal damage through their poison.
- The Nose GoblinChance to fire a booger that sticks to enemies and deals damage over time. trinket's effect is almost identical to Sinus Infection, with an added homing bonus.
- Not affected by Luck.
- 20/20Grants double shot./ The Inner EyeGrants triple shot but decreases tears./ Mutant SpiderGrants quadruple shot but decreases tears.: Each tear has a chance of being a booger tear. Increases chances of firing booger tears/
- Apple!Increases tears. Adds a chance to fire a high-damage razor blade.: Tears can gain the effects of razors, boogers, or both, though the chance for both to occur on the same tear is low. Razor blades visually override boogers in these cases.
- Chocolate MilkGrants charged tears that deal greater damage when fully charged.: Booger damage is influenced by the damage of the individual tear, so fully-charged Chocolate Milk shots can result in very potent damage over time.
- Compound FractureIncreases range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle./ The ParasiteIsaac's tears split in two when they hit something.: Tears and split tears have a chance of sticking to enemies. Booger tears will not split after killing enemies.
- Cricket's BodyGrants -1 Tear Delay and reduces Range. When tears hit an object or deplete their range, they spawn 4 smaller tears, whose Range and Damage scale with Isaac's.: Booger tears will split into split booger tears that can attach to enemies.
- GodheadIncreases damage and range while reducing tears and shot speed. Grants homing tears and tears gain a damaging halo.: Shots retain their aura while stuck to an enemy, but the aura can damage only enemies other than the booger victim. If the enemy dies while duration remains, it will resume homing and will often stick to a second enemy.
- Guppy: Every damage instance that a booger shot does while attached to an enemy will trigger a fly to spawn.
- HaemolacriaTears are now fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.: Booger tears still look like normal haemolacria tears and will attach to enemies until enemies die or time runs out. After that, the tear bursts.
- Head of the KeeperIsaac's tears become coins and now have a chance to drop pennies on the floor upon successfully hitting an enemy.: Every damage instance that a booger shot does while attached to an enemy will trigger a chance for a coin to spawn.
- LachryphagyIsaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage. : All tears have a chance to burst into boogers. Boogers will always burst into more boogers, though some of the boogers may incorrectly appear to be normal tears. When a booger sticks to a enemy, it will burst into 8 boogers which have a high chance of sticking again to the same enemy.
- Lost ContactEvery tear has a small shield which will allow it to block one enemy projectile.: Tears that stick to enemies will block shots and will not be destroyed upon blocking a shot, preventing an enemy from firing in a given direction until death or expiration of the effect.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: Booger tears will grow in size and damage as they travel. They are a blackish color.
- My ReflectionGives Isaac's tears a boomerang effect, and increases range and shot speed.: Boogers that fall off enemies will try to return to Isaac instead of falling straight down, making it easier for it to latch onto another enemy.
- PolyphemusMakes Isaac shoot one huge tear. Also reduces Tears to minimum. Damage increased . If tear does more damage than an enemy's life, the tear continues to travel with the extra remaining damage.: Booger shots lose the Polyphemus pierce effect, but stick to enemies while dealing the full damage of the Polyphemus shot. Damage does not degrade.
- ProptosisTears start out massive with high damage, and then shrink down and become weaker over a short range.: Shots that stick to enemies retain the damage they had at the moment of impact; no further decrease.
- Strange AttractorPickups, trinkets, and monsters are magnetically attracted to Isaac's tears.: Enemies will be attracted to other enemies who have been stuck with a booger tear.
- Technology ZeroConnects Isaac's tears with electricity that can damage enemies.: Booger tears will be connected to other tears via electricity.
- BrimstoneTears are replaced by a laser beam that pierces through all enemies and obstacles in its path and deals high damage. Can only be fired after a short charge-up period.: Overrides Sinus Infection.
- Guppy (Transformation) : Boogers attached to enemies continually spawn blue flies as they deal damage.
- Holy LightIsaac has a random chance to fire a Holy tear, which, when it hits an enemy, will spawn a Crack the Sky-style light beam on the same enemy, dealing damage.: Holy light strikes do not activate on booger shots.
- IpecacReplaces tears with explosive and poisoning projectiles fired in an arc from the mouth.: Overrides Sinus Infection. Booger tears will still appear, but will act identically to other Ipecac shots.
- Jacob's LadderTears fire sparks of electricity in random directions upon hitting an obstacle or enemy.: Lightning strikes do not activate on booger shots.
- The Ludovico TechniqueInstead of firing tears, Isaac controls one floating tear that hover over obstacles. This tear deals constant damage when held in place over an enemy.: The large tear has a chance to stick to enemies. The tear cannot be controlled while it is stuck to an enemy, and cannot be removed until the enemy has died. Additionally, the tear does not inflict poison damage.
- A Lump of CoalThe more distance tears travel, the more damage they will do.: Shots that stick to enemies retain the damage they had at the moment of impact; no further increase.
- Mom's KnifeIsaac's tears are replaced by a knife that pierces enemies, can travel through obstacles, and can hurt enemies while Isaac is holding it. Holding down the fire button before firing increases its range and power.: Overrides Sinus Infection.
- TechnologyReplaces tears with a piercing laser with unlimited range.: Overrides Sinus Infection.
- Tech XTears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the size of the ring.: Overrides Sinus Infection.
- TrisagionTears are replaced with piercing white blasts of light.: Overrides Sinus Infection.