Mycoplasma suis belongs to the hemotrophic mycoplasma group and causes infectious anemia in pigs. According to the present state of knowledge, this organism adheres to the surface of erythrocytes but does not invade them. We found a novel M. suis isolate that caused severe anemia in pigs with a fatal disease course. Interestingly, only marginal numbers of the bacteria were visible on and between the erythrocytes in acridine orange-stained blood smears for acutely diseased pigs, whereas very high loads of M. suis were detected in the same blood samples by quantitative PCR. These findings indicated that M. suis is capable of invading erythrocytes. By use of fluorescent labeling of M. suis and examination by confocal laser scanning microscopy, as well as scanning and transmission electron microscopy, we proved that the localization of M. suis was intracellular. This organism invades erythrocytes in an endocytosis-like process and is initially surrounded by two membranes, and it was also found floating freely in the cytoplasm. In conclusion, we were able to prove for the first time that a member of the hemotrophic mycoplasma group is able to invade the erythrocytes of its host. Such colonization should protect the bacterial cells from the host's immune response and hamper antibiotic treatment. In addition, an intracellular life cycle may explain the chronic nature of hemotrophic mycoplasma infections and should serve as the foundation for novel strategies in hemotrophic mycoplasma research (e.g., treatment or prophylaxis).Mycoplasma suis is a member of the family Mycoplasmataceae. This organism belongs to a group of uncultivable highly specialized bacteria which parasitize the surface of erythrocytes of a variety of mammals (34). These species represent a distinct new cluster in the genus Mycoplasma and have been given the trivial name hemotrophic mycoplasmas (HM). Infections with HM are identified clinically by overt life-threatening hemolytic anemia or by subtle chronic anemia characterized by infertility, immune suppression, and greater susceptibility to infections (34). It is noteworthy that organisms that morphologically resemble HM have also been detected in the blood of humans (1,8,42,50).M. suis causes febrile acute icteroanemia in pigs (IAP), which is accompanied by high numbers of M. suis cells in the blood, as confirmed by microscopy as well as by PCR (18,21,34). Clinical symptoms are successfully cured by treatment with tetracycline. Nevertheless, once pigs are infected with M. suis, they remain lifelong carrier animals and therefore are epidemiologically important (19). Chronic M. suis infections result in reproductive disorders in sows, growth retardation in piglets, and increased susceptibility to respiratory and enteric infections in feeder pigs. M. suis occurs worldwide, and chronic IAP, in particular, is of major economic importance (19).Contrary to the well-established clinical picture of IAP (i.e., high morbidity and low mortality), we recently observed an increased incidence of acute IAP in feed...