Scholars@Duke
Thuy Le

Thuy Le

Associate Professor of Medicine
Medicine, Infectious Diseases
Duke Box 102359, Durham, NC 27710, Durham, NC 27710
315 Trent Drive, Room #257, Durham, NC 27710

Scholarly Works - Journal articles

In Vitro Evaluation of Olorofim and Amphotericin B Combination Therapy Against Talaromyces marneffei

Journal article Journal of Fungi · June 1, 2026 The dimorphic fungus Talaromyces marneffei causes talaromycosis, a life-threatening fungal disease with limited treatment options. Olorofim, a first-in-class orotomide antifungal that targets pyrimidine synthesis essential for fungal growth, has low minimu ... Full text Cite

Histoplasmosis: a missing piece in the global efforts to end HIV deaths.

Journal article Lancet HIV · May 2026 Histoplasmosis is a leading opportunistic infection and cause of mortality in people with advanced HIV disease. Yet, histoplasmosis is largely neglected in the global HIV response. Previously considered endemic only in the region of the Americas, histoplas ... Full text Link to item Cite

Fluconazole plus flucytosine versus fluconazole alone for adults with HIV-associated cryptococcal antigenaemia identified through screening: a multi-centre phase III randomised-controlled trial.

Journal article Trials · March 24, 2026 BACKGROUND: Despite the expansion of antiretroviral treatment programmes, the incidence and mortality of HIV-associated cryptococcal meningitis remain high in Africa. Cryptococcal antigen (CrAg) in the blood precedes meningitis. CrAg screening of individua ... Full text Link to item Cite

Antigen detection of Talaromyces infection in the US: Case report

Journal article Medical Mycology Case Reports · March 1, 2026 Talaromycosis is an invasive fungal infection endemic in Southeast Asia and has emerged as a leading cause of HIV-related death in the highly endemic countries of Vietnam, Thailand and China. Travel-related cases have been increasingly reported in immunoco ... Full text Cite

Clinical Performance of a Mp1p Antibody Detection Immunoassay For Talaromycosis.

Journal article medRxiv · February 14, 2026 BACKGROUND: Talaromycosis, caused by the fungus Talaromyces marneffei, is a leading cause of HIV-associated death in Southeast Asia. Current culture-based diagnosis only identifies late-stage infection, limiting understanding of disease burden and disease ... Full text Link to item Cite

Recent Advances in the Diagnosis of Talaromycosis.

Journal article Clin Infect Dis · February 4, 2026 Talaromycosis is an invasive fungal disease endemic to Southeast Asia. While culture is essential in identification, susceptibility testing, and typing, the low sensitivity and long turnaround times limit its clinical utility. Several promising monoclonal ... Full text Link to item Cite

Development and Clinical Evaluation of a Novel Talaromyces marneffei Mp1p Lateral Flow Assay for Rapid Diagnosis of Talaromycosis.

Journal article Clin Infect Dis · January 6, 2026 BACKGROUND: The diagnosis of talaromycosis, a life-threatening invasive fungal disease endemic in Southeast Asia, still relies on protracted culture methods. We report the development and clinical evaluation of a novel lateral flow assay (LFA) for the rapi ... Full text Link to item Cite

Development Framework of Desirability of Outcome Ranking Endpoints for Use in Clinical Trials of Invasive Fungal Diseases.

Journal article Open Forum Infect Dis · January 2026 BACKGROUND: Current Mycosis Study Group Education and Research Consortium (MSGERC) and European Confederation of Medical Mycology (ECMM) response criteria for clinical trials often fail to comprehensively assess outcomes of the total patient experience, pr ... Full text Link to item Cite

In vitro evidence to support amphotericin B and flucytosine combination therapy for talaromycosis.

Journal article PLoS Negl Trop Dis · December 2025 BACKGROUND: Talaromyces marneffei causes talaromycosis, a life-threatening fungal disease with limited treatment options. The standard treatment of amphotericin B (AmB) induction followed by itraconazole consolidation still results in 15% to 30% mortality. ... Full text Link to item Cite

Comparative performance of a commercial and in-house Mp1p antigen-detecting enzyme immunoassay for the rapid diagnosis of talaromycosis.

Journal article PLoS Negl Trop Dis · August 2025 BACKGROUND: Several antigen-detection assays have been developed for the rapid diagnosis of talaromycosis, but their utility has been limited by a lack of commercial options. The aim of this study was to perform a head-to-head comparison of the performance ... Full text Link to item Cite

Multicenter Case-Control Study of Behavioral, Environmental, and Geographic Risk Factors for Talaromycosis, Vietnam.

Journal article Emerg Infect Dis · July 2025 Talaromycosis is a life-threatening fungal disease that primarily affects immunocompromised persons in Southeast Asia. We conducted a multicenter, case-control study recruiting participants with advanced HIV disease in Vietnam; 205 case-patients with cultu ... Full text Link to item Cite

Optimization and clinical evaluation of a 5.8S rRNA quantitative PCR assay for the diagnosis of talaromycosis.

Journal article Med Mycol · April 2, 2025 Talaromyces marneffei is a dimorphic fungus endemic in Southeast Asia that causes the invasive fungal disease talaromycosis in immunocompromised individuals. Detection of T. marneffei nucleic acid in blood by PCR has demonstrated potential as a diagnostic ... Full text Link to item Cite

Talaromyces marneffei, Coccidioides species, and Paracoccidioides species-a systematic review to inform the World Health Organization priority list of fungal pathogens.

Journal article Med Mycol · June 27, 2024 The World Health Organization, in response to the growing burden of fungal disease, established a process to develop a fungal pathogen priority list. This systematic review aimed to evaluate the epidemiology and impact of infections caused by Talaromyces m ... Full text Link to item Cite

Development and validation of a colorimetric antifungal susceptibility testing method for the dimorphic fungus Talaromyces marneffei.

Journal article Med Mycol · November 6, 2023 Antifungal drug resistance is an emerging cause of treatment failure in invasive fungal infections, and antifungal susceptibility testing (AFST) may inform treatment decisions. Currently, there are no established AFST guidelines for Talaromyces marneffei ( ... Full text Link to item Cite

Impact of pathogen genetics on clinical phenotypes in a population of Talaromyces marneffei from Vietnam.

Journal article Genetics · August 9, 2023 Talaromycosis, a severe and invasive fungal infection caused by Talaromyces marneffei, is difficult to treat and impacts those living in endemic regions of Southeast Asia, India, and China. While 30% of infections result in mortality, our understanding of ... Full text Link to item Cite

Environmentally Resilient Microfluidic Point-of-Care Immunoassay Enables Rapid Diagnosis of Talaromycosis.

Journal article ACS Sens · June 23, 2023 Point-of-care tests (POCTs) are increasingly being used in field settings, particularly outdoors. The performance of current POCTs─most commonly the lateral flow immunoassay─can be adversely affected by ambient temperature and humidity. We developed a self ... Full text Link to item Cite

Noninvasive Testing and Surrogate Markers in Invasive Fungal Diseases.

Journal article Open Forum Infect Dis · June 2022 Invasive fungal infections continue to increase as at-risk populations expand. The high associated morbidity and mortality with fungal diseases mandate the continued investigation of novel antifungal agents and diagnostic strategies that include surrogate ... Full text Link to item Cite

Immunologic Change over 72 Weeks Following Raltegravir- Versus Efavirenz-Based Therapy in HIV/HCV-Coinfected Individuals in Vietnam.

Journal article AIDS Res Hum Retroviruses · June 2022 The impact of HIV antiretroviral therapy (ART) on immune dysregulation associated with hepatitis C virus (HCV)/HIV coinfection is incompletely understood. We serially assessed monocyte activation (neopterin, sCD14, and sCD163) and T cell activation (HLA-DR ... Full text Link to item Cite

COVID-19 Trials: Who Participates and Who Benefits?

Journal article South Med J · April 2022 OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately afflicted vulnerable populations. Older adults, particularly residents of nursing facilities, represent a small percentage of the population but account for 40% of mortalit ... Full text Open Access Link to item Cite

Talaromyces marneffei promotes M2-like polarization of human macrophages by downregulating SOCS3 expression and activating the TLR9 pathway.

Journal article Virulence · December 2021 Little is known about how Talaromyces marneffei, a thermally dimorphic fungus that causes substantial morbidity and mortality in Southeast Asia, evades the human immune system. Polarization of macrophages into fungal-inhibiting M1-like and fungal-promoting ... Full text Link to item Cite

Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology.

Journal article Lancet Infect Dis · December 2021 The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient ... Full text Open Access Link to item Cite

A global call for talaromycosis to be recognised as a neglected tropical disease.

Journal article Lancet Glob Health · November 2021 Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects p ... Full text Link to item Cite

Curvularia alcornii Aortic Pseudoaneurysm Following Aortic Valve Replacement: Case Report and Review of the Literature.

Journal article Open Forum Infect Dis · November 2021 We report the first case of Curvularia alcornii aortic pseudoaneurysm following bioprosthetic aortic valve replacement in an immunocompetent host. Infection was complicated by septic emboli to multiple organs. Despite aggressive surgical intervention and a ... Full text Open Access Link to item Cite

Population Pharmacokinetics and Pharmacodynamics of Itraconazole for Disseminated Infection Caused by Talaromyces marneffei.

Journal article Antimicrob Agents Chemother · October 18, 2021 First-line treatment of talaromycosis with amphotericin B deoxycholate (DAmB) is labor-intensive and toxic. Itraconazole is an appealing alternative antifungal agent. Pharmacokinetic data were obtained from 76 patients who were randomized to itraconazole i ... Full text Link to item Cite

Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis.

Journal article Mycopathologia · October 2021 Talaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompete ... Full text Open Access Link to item Cite

Superiority of a Novel Mp1p Antigen Detection Enzyme Immunoassay Compared to Standard BACTEC Blood Culture in the Diagnosis of Talaromycosis.

Journal article Clin Infect Dis · July 15, 2021 BACKGROUND: Talaromycosis is an invasive mycosis endemic in Southeast Asia and causes substantial morbidity and mortality in individuals with advanced human immunodeficiency virus (HIV) disease. Current diagnosis relies on isolating Talaromyces marneffei i ... Full text Open Access Link to item Cite

Cost-Effectiveness of Amphotericin B Deoxycholate Versus Itraconazole for Induction Therapy of Talaromycosis in Human Immunodeficiency Virus-Infected Adults in Vietnam.

Journal article Open Forum Infect Dis · July 2021 BACKGROUND: Talaromycosis (penicilliosis) is an invasive fungal infection and a major cause of human immunodeficiency virus (HIV)-related deaths in Southeast Asia. Guidelines recommend induction therapy with amphotericin B deoxycholate; however, treatment ... Full text Open Access Link to item Cite

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials.

Journal article Nat Commun · April 15, 2021 Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine a ... Full text Open Access Link to item Cite

Prognosis and treatment effects of HIV-associated talaromycosis in a real-world patient cohort.

Journal article Med Mycol · April 6, 2021 Talaromycosis is a leading cause of AIDS-associated opportunistic infections and death in Southeast Asia. We have recently shown in the Itraconazole versus Amphotericin for Talaromycosis (IVAP) trial that induction therapy with amphotericin B reduced morta ... Full text Open Access Link to item Cite

Neurocognitive Trajectories After 72 Weeks of First-Line Anti-retroviral Therapy in Vietnamese Adults With HIV-HCV Co-infection

Journal article Frontiers in Neurology · March 12, 2021 Background: Long-term neurocognitive outcomes following first-line suppressive anti-retroviral therapy (ART) remain uncertain for individuals with HIV and hepatitis C (HCV) co-infection. The study examined neurocognitive performance before and after 72 wee ... Full text Open Access Cite

Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017.

Journal article HIV Med · December 2020 OBJECTIVES: Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China. METHODS: We retrospectively evaluate ... Full text Open Access Link to item Cite

Occult Talaromyces marneffei Infection Unveiled by the Novel Mp1p Antigen Detection Assay.

Journal article Open Forum Infect Dis · November 2020 Talaromyces marneffei causes fatal invasive mycosis in Southeast Asia. Diagnosis by culture has limited sensitivity and can result in treatment delay. We describe the use of a novel Mp1p enzyme immunoassay (EIA) to identify blood culture-negative talaromyc ... Full text Open Access Link to item Cite

Complete Genome Sequences for Two Talaromyces marneffei Clinical Isolates from Northern and Southern Vietnam.

Journal article Microbiol Resour Announc · January 9, 2020 Talaromyces marneffei is a thermally dimorphic fungus endemic in China and Southeast Asia that causes fatal infections in immunocompromised individuals, particularly in patients with advanced HIV disease. Here, we report the complete genome sequences of tw ... Full text Open Access Link to item Cite

Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries.

Journal article Lancet Infect Dis · April 2019 In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-incom ... Full text Open Access Link to item Cite

Population Pharmacodynamics of Amphotericin B Deoxycholate for Disseminated Infection Caused by Talaromyces marneffei.

Journal article Antimicrob Agents Chemother · February 2019 Amphotericin B deoxycholate (DAmB) is a first-line agent for the initial treatment of talaromycosis. However, little is known about the population pharmacokinetics and pharmacodynamics of DAmB for talaromycosis. Pharmacokinetic data were obtained from 78 p ... Full text Open Access Link to item Cite

Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/AIDS patients receiving antiretroviral therapy: a retrospective cohort study.

Journal article Emerg Microbes Infect · 2019 The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folic acid synthesis which is important for the survival of many bacteria, protozoa, and fungi and ... Full text Open Access Link to item Cite

Differential prevalence and geographic distribution of hepatitis C virus genotypes in acute and chronic hepatitis C patients in Vietnam.

Journal article PLoS One · 2019 BACKGROUND: The highest burden of disease from hepatitis C virus (HCV) is found in Southeast Asia, but our understanding of the epidemiology of infection in many heavily burdened countries is still limited. In particular, there is relatively little data on ... Full text Open Access Link to item Cite

Detection and Characterization of Human Pegivirus 2, Vietnam.

Journal article Emerg Infect Dis · November 2018 We report human pegivirus 2 (HPgV-2) infection in Vietnam. We detected HPgV-2 in some patients with hepatitis C virus/HIV co-infection but not in patients with HIV or hepatitis A, B, or C virus infection, nor in healthy controls. HPgV-2 strains in Vietnam ... Full text Open Access Link to item Cite

Clinical features of three patients with paradoxical immune reconstitution inflammatory syndrome associated with Talaromyces marneffei infection

Journal article Medical Mycology Case Reports · March 1, 2018 Talaromyces marneffei infection is a major cause of death in HIV-infected individuals in South and Southeast Asia. Talaromycosis immune reconstitution inflammatory syndrome has not been well described. Here we report the clinical features, management, and ... Full text Open Access Cite

Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease.

Journal article Respiration · 2018 Featured Publication Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where dise ... Full text Open Access Link to item Cite

Fungal infections in HIV/AIDS.

Journal article Lancet Infect Dis · November 2017 Fungi are major contributors to the opportunistic infections that affect patients with HIV/AIDS. Systemic infections are mainly with Pneumocystis jirovecii (pneumocystosis), Cryptococcus neoformans (cryptococcosis), Histoplasma capsulatum (histoplasmosis), ... Full text Open Access Link to item Cite

A Trial of Itraconazole or Amphotericin B for HIV-Associated Talaromycosis.

Journal article N Engl J Med · June 15, 2017 BACKGROUND: Talaromyces marneffei infection is a major cause of human immunodeficiency virus (HIV)-related death in South and Southeast Asia. Guidelines recommend initial treatment with amphotericin B deoxycholate, but this drug has substantial side effect ... Full text Open Access Link to item Cite

AIDS-Related Mycoses: Current Progress in the Field and Future Priorities

Journal article Trends in Microbiology · June 2017 Featured Publication Full text Open Access Cite

Looking for fungi in all the right places: screening for cryptococcal disease and other AIDS-related mycoses among patients with advanced HIV disease.

Journal article Curr Opin HIV AIDS · March 2017 PURPOSE OF REVIEW: As HIV treatment programmes scale up to meet the UNAIDS 90-90-90 goals, care must be taken to start antiretroviral treatment safely in patients with advanced disease (CD4 counts <200 cells/μl) who are simultaneously at risk for opportuni ... Full text Open Access Link to item Cite

The impact of HCV therapy in a high HIV-HCV prevalence population: A modeling study on people who inject drugs in Ho Chi Minh City, Vietnam.

Journal article PLoS One · 2017 BACKGROUND: Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) coinfection is a major global health problem especially among people who inject drugs (PWID), with significant clinical implications. Mathematical models have been used to great eff ... Full text Open Access Link to item Cite

Development and evaluation of a real-time polymerase chain reaction assay for the rapid detection of Talaromyces marneffei MP1 gene in human plasma.

Journal article Mycoses · December 2016 Penicilliosis caused by Talaromyces marneffei is a common AIDS-defining illness in South and Southeast Asia. Diagnosis is based on culture which can take up to 14 days for identification, leading to treatment delay and increased mortality. We developed a T ... Full text Open Access Link to item Cite

High prevalence of PI resistance in patients failing second-line ART in Vietnam.

Journal article J Antimicrob Chemother · March 2016 BACKGROUND: There are limited data from resource-limited settings on antiretroviral resistance mutations that develop in patients failing second-line PI ART. METHODS: We performed a cross-sectional virological assessment of adults on second-line ART for ≥6 ... Full text Open Access Link to item Cite

Adjunctive Dexamethasone in HIV-Associated Cryptococcal Meningitis

Journal article New England Journal of Medicine · February 11, 2016 Full text Open Access Cite

Diagnosing Rhodococcus equi infections in a setting where tuberculosis is highly endemic: a double challenge.

Journal article J Clin Microbiol · April 2015 Rhodococcus equi infection is increasing in regions with high HIV prevalence worldwide. The microbiological features and clinical mimicry of tuberculosis infection pose diagnostic challenges in high-tuberculosis-incidence settings. We present two HIV-assoc ... Full text Open Access Link to item Cite

Environmental predictors and incubation period of AIDS-associated penicillium marneffei infection in Ho Chi Minh City, Vietnam.

Journal article Clin Infect Dis · May 2013 BACKGROUND: Penicillium marneffei is an emerging dimorphic mycosis endemic in Southeast Asia, and a leading cause of mortality among human immunodeficiency virus (HIV)-infected people in the region. Factors governing the seasonal incidence of P. marneffei ... Full text Open Access Link to item Cite

Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam

Journal article AIDS Research and Therapy · August 16, 2012 Objective: This study reports the clinical characteristics and outcome of HIV-associated Penicilliummarneffei infection in northern Vietnam.Methods: We conducted a retrospective chart review of all patients with laboratory confirmed Penicilliummarneffei in ... Full text Open Access Cite

HIV-1 drug resistance in antiretroviral-naive individuals with HIV-1-associated tuberculous meningitis initiating antiretroviral therapy in Vietnam.

Journal article Antivir Ther · 2012 BACKGROUND: Access to antiretroviral therapy (ART) for HIV-infected individuals in Vietnam is rapidly expanding, but there are limited data on HIV drug resistance (HIVDR) to guide ART strategies. METHODS: We retrospectively conducted HIVDR testing in 220 A ... Full text Open Access Link to item Cite

The decline of typhoid and the rise of non-typhoid salmonellae and fungal infections in a changing HIV landscape: bloodstream infection trends over 15 years in southern Vietnam.

Journal article Trans R Soc Trop Med Hyg · January 2012 The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh C ... Full text Open Access Link to item Cite

Epidemiology, seasonality, and predictors of outcome of AIDS-associated Penicillium marneffei infection in Ho Chi Minh City, Viet Nam.

Journal article Clin Infect Dis · April 1, 2011 BACKGROUND: Penicillium marneffei is an important human immunodeficiency virus (HIV)-associated opportunistic pathogen in Southeast Asia. The epidemiology and the predictors of penicilliosis outcome are poorly understood. METHODS: We performed a retrospect ... Full text Open Access Link to item Cite

AIDS-associated Penicillium marneffei infection of the central nervous system.

Journal article Clin Infect Dis · December 15, 2010 Penicillium marneffei is an important human immunodeficiency virus-associated opportunistic infection endemic in Southeast Asia. Central nervous system infection has not been described. We report the first case series of 21 human immunodeficiency virus-inf ... Full text Open Access Link to item Cite

AIDS‐associated Cryptococcus neoformans and Penicillium marneffei coinfection: a therapeutic dilemma in resource‐limited settings.

Journal article Clin Infect Dis · November 1, 2010 AIDS‐associated Cryptococcus neoformans and Penicillium marneffei coinfection has not been adequately studied and poses unique therapeutic challenges in resource‐limited settings. Itraconazole poorly penetrates the central nervous system, whe ... Full text Open Access Link to item Cite

Low-abundance HIV drug-resistant viral variants in treatment-experienced persons correlate with historical antiretroviral use.

Journal article PLoS One · June 29, 2009 BACKGROUND: It is largely unknown how frequently low-abundance HIV drug-resistant variants at levels under limit of detection of conventional genotyping (<20% of quasi-species) are present in antiretroviral-experienced persons experiencing virologic failur ... Full text Open Access Link to item Cite