5. MODE OF TRANSMISSION

Through the bite of arthropods, including the wood tick Dermacentor andersoni, the dog tick D. variabilis, the lone star tick Amblyomma americanum, less commonly the deer fly Chrysops discails and, in Sweden, the mosquito Aedes cinereus; by inoculation of skin, conjunctival sac or oropharyngeal mucosa with contaminated water, blood or tissue while handling carcasses of infected animals (e.g., skinning, dressing or performing necropsies); by handling or ingesting insufficiently cooked meat of infected animal hosts; by drinking contaminated water; by inhalation of dust from contaminated soil, grain or hay; rarely, from bites of coyote, squirrel, skunk, hog, cat and dog whose mouth presumably was contaminated from eating an infected animal; and from contaminated pelts and paws of animals. Laboratory infections occur and frequently present as a primary pneumonia or typhoidal tularemia.