Stage 3' has Bottomless Pits with disembodied hands. Fall into one, and you get to hear your character scream as they get pulled in.
Despite the game's fairly bright atmosphere and 90's anime style, the first scene you see is of a human sacrifice, and if that weren't enough, Dracula's first appearance is just a black shadow where you can only see his eyes.
There is something unsettling about how the Maneating Plant, found behind a wall on the hidden path in Stage 1, and the only one in this entry in the series, screams when you kill it.
This game's rendition of "Poison Mind" when you face off against Shaft and his monsters and before you face off against Dracula is much creepier than the original NES version, to the point of sounding like an Ominous Pipe Organ.