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There are a few units with the special ability Plague Carrier (denoted by an icon that looks like a bearded face or something) and they have a chance of causing other units in the province to become diseased. These units are very rare, namely only the Apparition and the Eater of the Dead are ones I can remember offhand.
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+ The Man with the Iron Crutch.
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I looked thru the strat guide and manual, but couldn't find any "spread" info beyond the sieging spread into the castle due to starvation.
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Any starving unit can get diseased, not just ones in castles.