The most prominent symptoms are fever and lymph node enlargement. But there is a wide range of clinical manifestations, especially in enzootic areas. Among them, the Doukkala area of Morocco, where the epidemiology and symtomatology of the disease were minutely studied. 
The disease was once considered as "benign" in the literature, in comparison to East coast fever. But with the introduction of European breeds in the region, it could become of major economic incidence. 
An efficient treatment with parvaquone, then buparvaquone became available in many countries from the mid 1990s.
Body temperature is regularly higher than in any other cattle disease. Fever from 41 to 42°C are common in acute stages. Later on (day 5 to day 10 from the clinical onset), temperature will lower, to normal range (38.0-39.5°C). But, the disease continue to progress, despite a possible apparent clinical improve (appetite comes back). Afterwards, from D10 to D15, they is a downfall stage, with hypothermia (37 to 38°C), anemia, subicterus, and heart failure. Such animals rarely recover, even with intensive treatment.
Other signs, but not present in all cases are :
Lymph node enlargement and even hyperthermia can occur asymptomatically in enzootic area, during the disease season.
Hence, diagnosis must be based on objective pathological signs like anorexia or drastic reduction of milk production in dairy cows.