Which signs are commonly seen in botulism?

• A. Constipation, respiratory failure, and neurologic decline
• B. Diarrhea and dehydration
• C. Rash and itching
• D. Seizures and hyperreflexia

Answer: (B)

Botulism toxin blocks acetylcholine release at the neuromuscular junction, causing a descending, symmetric, flaccid paralysis with prominent cranial nerve involvement and autonomic dysfunction. Early signs are eye problems like diplopia and ptosis, with dysarthria and dysphagia, followed by weakness that descends to affecting a broader set of muscles. Autonomic effects can include constipation and dry mouth. Because of this pattern, constipation, respiratory failure from diaphragmatic weakness, and a progressive neurologic decline fit botulism best. Diarrhea and dehydration are not typical core features, and rash with itching or seizures with hyperreflexia do not align with this neuroparalytic picture.