At 4:28 p.m. on Dec. 12, little Harley Livingston was admitted to Conemaugh Memorial Hospital in Johnstown with diaper rash so severe that dead tissue in his genital area was turning black.

At 4:49 p.m., the 15-month-old went into cardiac arrest and at 5:06 p.m., he died.

Now, in one of the more bizarre and sad cases he said he has ever seen, Cambria County Coroner Dennis Kwiatkowski has ruled that the toddler died from dehydration and bacterial infection induced by a severe diaper rash. As a result, both the toddler's mother and grandmother are facing criminal charges.

The mother, Amy Livingston, 27, of Johnstown, was jailed after she was arraigned Tuesday on one count of involuntary manslaughter and two counts of endangering the welfare of children.

She not only was charged with causing the death of Harley by allowing him to develop diaper rash that became septic, but with endangering the welfare of her son Hunter, who will be 4 next month. He also was suffering from severe diaper rash when authorities checked on his condition after his brother died.

The children's grandmother, Evelyn Ann Mrsnik, 60, of Richland, Cambria County, was charged with one count of endangering the welfare of children for failing to report suspected child neglect of her grandson to authorities.

Mrsnik was a supervisor at a day-care center where the children stayed. Under Pennsylvania law, she was required to notify authorities of any suspected child abuse or neglect.

Livingston was placed in the Cambria County Jail after failing to post $200,000 bail. Mrsnik was released after posting 10 percent of a $150,000 bond.

District Judge Michael Musulin of Johnstown set a preliminary hearing date for both women for next Thursday.

When Livingston took her son to the emergency room on Dec. 12, he was wearing a clean diaper but was dehydrated, his eyes were dry and sunken, and he was turning blue, according to a criminal affidavit filed by detectives Thomas Owens and Donald Robertson.

Harley's mother said she took him into the hospital because he appeared to be lethargic. She said he would not eat that morning but had been teething and had diarrhea.

When questioned about a bruise on his forehead and right side of the head, his mother offered several explanations: He had fallen into a wall, he had been bitten at day care and he was learning how to walk.

A friend of Livingston's told police that Harley had fallen and struck his head on the previous day. But the coroner's office did not link that fall to the toddler's death.

On Dec. 12, detectives searched Amy Livingston's home and found it in shambles. Trash and food covered the floor and the smell was almost unbearable. A plastic bag in the hallway was filled with trash and used diapers and the sheet from the crib was heavily stained and on the floor, according to the affidavit.

Her husband, David Livingston, who was deployed with the U.S. Army, was not present. According to the affidavit, other persons had stayed at the house on and off.

Cambria County Children and Youth Services had been trying to work with Livingston, who had been noncompliant with court orders since September, according to the affidavit.

Shortly after performing an autopsy, the coroner's office ruled that the cause of Harley's death was sepsis, a bacterial infection that entered his bloodstream.

Kwiatkowski said that the bacterial infection was fast-moving. Only once previously in his 25 years in the coroner's office, he said, had he seen a similar death.

He said the coroner's office redid the blood work and re-examined the evidence. "Any time you are handling a baby death, it is harder," Kwiatkowski said. "You want to make sure you dot your i's and cross your t's."

On Feb. 25, after a meeting with its officials, the coroner's office ruled that the death was a homicide.

District Attorney David Tulowitzki decided to file charges against both mother and grandmother.

Tulowitzki's decision to charge Mrsnik with failing to report possible abuse was based on an investigation at the day-care center where she worked and the children stayed.

"On numerous occasions, staff members would report the seriousness of the diaper rash to her," Tulowitzki said yesterday. He said she did not report the allegations to the state, even though she was a mandatory reporter.

Dr. Marian Michaels, an infectious disease specialist at Children's Hospital, said she has never witnessed a death from complications from diaper rash. But she said she has seen deaths in children from overwhelming bacterial infections that entered through minor breaks in the skin.

While deaths from those causes are unusual in otherwise healthy children, serious infections can move rapidly "despite every appropriate treatment," she said. The presence of feces or urine in a diaper could cause skin breakdown and create the opportunity for infection to enter the body, she said.

Sometimes, children may have underlying immune deficiencies that go unnoticed until overwhelming infection occurs, she said.

The coroner said Harley did not have underlying health problems.

Dr. Joseph Carcillo, a critical care specialist at Children's, said some conditions known to cause similar symptoms include necrotizing fasciitis, a fast-moving infection of the tissue beneath the skin, or Fournier's disease, a rapid infection involving the genital area. Both are types of flesh-eating disease that can quickly result in death.

The coroner could not be reached later yesterday to discuss whether those diseases were a factor in the child's death.