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The brain and spinal cord become infected with the syphilis bacterium, Treponema pallidum, during the secondary stage of infection and can remain latent for 10 to 20 years after the initial infection

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The association was also adjusted for self-reported and hospital diagnosed chronic obstructive pulmonary disease (COPD) and chronic pulmonary infections (definitions in eTable 3) at baseline, which may be important confounding factors [33, 34]

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