Lewis Moody has been ruled out of England’s second match in the RBS 6 Nations, against Italy in Rome on Sunday, due to an Achilles tendon injury.

The Leicester Tigers flanker is among four England players sidelined following the opening defeat by Wales at Twickenham.

Gloucester’s Mike Tindall suffered bruising to his liver and was admitted to hospital for observation. Harlequins winger David Strettle picked up a foot injury and Wasps flanker Tom Rees, who replaced Moody after just quarter of an hour of Saturday’s match, hurt the medial collateral ligament of his left knee.

Injury to Rees meant Leicester lock Ben Kay emerged from the replacements’ bench at half-time to earn his 54th cap in the unusual position of the England back row.

Ireland’s Geordan Murphy was the only one of Leicester’s senior internationals to enjoy a winning start to the Six Nations, playing on the left wing in a 16-11 victory over Italy at Croke Park. Martin Castrogiovanni was credited with the Italy try on the hour mark but left the field in the closing minutes of his 50th senior cap.

James Hamilton started in Scotland’s second row and played the first hour of Sunday’s 27-6 defeat at home to France.