ese ndings were further supported by Büttiker et al. (2022) in their review of the long- term neuropsychiatric sequelae of human immunodeciency virus, herpes simplex virus, severe acute respiratory syndrome coronavirus- 2, and Ebolavirus. From their review, Büttiker et al. (2022) concluded that these viruses share a common mechanism for systemic infection and neuro- invasion in terms of the way they attack the brain and disrupt neuropsychiatric function during the acute and latent phases. All these viruses are associated with encephalopathies (e.g., meningitis or encepha­litis, seizures, or strokes) with altered mental status, so- called brain fog, fatigue, and increased neuropsychiatric incidence of anxiety, depression, and post- traumatic stress. e authors proposed a holistic cycle of neuropsychiatric eects and latent viral infection, whereby the primary acute and latent virulent brain pathogenesis can subside, only to give rise to exteroceptive- induced neuropsychiatric eects that surge in response to secondary environmental stressors. is is possible because all these viruses, including Ebolaviruses, are not fully purged from the CNS immunologically but reside in viral reservoirs that can cause a resurgence in CNS viral load and brain infection should the blood– brain barrier be compromised from environmental stress or other illness or trauma (Büttiker et al., 2022). e authors describe this dynamic as a cycle of primary virulent activity and secondary stress- induced reactivation.

In a review of the extent to which hearing loss is associated with Zika, Ebola, and Lassa fever, the authors were able to nd 21 articles evaluating neurological com­plications in a total of 3350 EVD survivors (Tshala- Katumbay et al., 2023). Of these survivors, 190 (5.7 percent) were observed to have hearing loss, with a strong rela­tionship between severity of infection (i.e., viral load during the acute phase) and severity of hearing loss (Ficenec et al., 2019). Given the lack of standardization of re­porting and measurement in such cases, the authors believe that the true prevalence of hearing loss from neuroEbola is likely to be much greater and that audiometric evaluation should be a part of all medical follow- up for survivors.