Since the peak infection period occurs when few people spend time in the woods, even severe outbreaks may go unnoticed initially. More commonly, hunters will find carcasses or notice recovering animals during the hunting season. Occasionally, in late summer, someone will observe a sick deer or a carcass in or near water.
The observable signs of infection vary with the three forms of HD: peracute, acute, and chronic. The peracute form, characterized by its rapid onset, is the most dramatic. Deer may exhibit a loss of awareness of their surroundings, very high fever, difficulty in breathing, swelling of the head and neck, and the bluish coloration and swelling of the tongue that makes "bluetongue" a common name of the disease. Death from the peracute form often occurs within 24 hours. In especially severe cases deer may die suddenly, even before any observable signs are evident.
With the acute or classic form of HD, deer live somewhat longer. In addition to swelling associated with the peracute form, these animals may show hemorrhaging in the heart, rumen, and intestines. They may also have ulcers on the tongue, dental pad, palate, rumen, and omasum.
Many hunters are familiar with the hoof sloughing associated with the chronic form of hemorrhagic disease because the condition frequently persists into the winter. An interruption of growth, resulting from high fever, often causes the hooves to appear broken or ringed. In extreme cases the tips of the hooves will actually slough off. Debilitated deer may crawl on their knees or even push along on their chest, resulting in additional lesions on those areas. Although less frequently noticed, the lining of the rumen may also become ulcerated, scarred, or even eroded. The deer's ability to absorb nutrients from ingested food is compromised when significant amounts of papillae, the finger-like projections on the rumen wall, are lost. Emaciation can result, even in the presence of ample food resources.