Italy's World Cup woes are set to deepen with reports that midfielder Daniele De Rossi could miss their Group D decider against Uruguay on Tuesday after being forced to undergo tests on his right calf.

The four-time champions made a solid start to the tournament thanks to a 2-1 win over England but Azzurri hopes of making the last 16 are now delicately balanced following a shock 1-0 defeat to Costa Rica.

With Costa Rica already qualified, Italy need a draw against Uruguay in Natal if they are to avoid the fate of England, who were eliminated by Friday's result in Recife.

De Rossi, meanwhile, could miss the game after finishing Friday's clash with a sore right calf which required him to undergo an MRI scan.

Team doctor Enrico Castellacci is expected to announce later Saturday whether the Roma midfielder will be ruled out or not.

The loss of De Rossi, considered one of the pillars of Italy's side, would prove a blow ahead of a match that Italy can ill afford to lose four years after suffering the embarrassment, as defending champions, of first round elimination.

Uruguay appear to have the momentum having bounced back from a 3-1 defeat to Costa Rica in their Group D opener with a 2-1 win over England thanks to a double from Liverpool striker Luiz Suarez.

"Right now, we have to focus solely on what we need to do against Suarez and company," said Italy forward Antonio Cassano after making his World Cup debut as a first-half replacement for midfielder Thiago Motta.

The Azzurri were a pale shadow of the side that looked so in control against England in hot and humid Manaus last week.

Fears that Italy are suffering from fatigue, having also had to prepare for a Costa Rica side already used to playing in hot and humid conditions, were borne out by the players comments after the game.

"In the second half we suffered, the heat made it difficult to remain lucid," said Italy midfielder Claudio Marchisio. "But we didn't concede a second goal so we've maintained our chances of qualifying."

With England already eliminated, Italy and Uruguay -- who both have three points -- will battle for the second qualifying spot.

But because Uruguay have a worse goal difference, they need to beat Italy if they are to repeat their exploits of 2010 when they reached the semi-finals.

Azzurri coach Cesare Prandelli admitted many of his players lacked freshness against Costa Rica. With Uruguay also used to playing in such temperatures, he said "maintaining order" on Tuesday will be crucial.

"I saw a lot of players who were tired, not just (Andrea) Pirlo," said Prandelli responding to a question about the lack of impact from the experienced Italy midfielder, whose pinpoint passing had unsettled the English in the opening game.

"Among the problems we have to now address is trying to maintain better order on the pitch so that we can allocate our resources better."

He added: "I've said it before. We're not as explosive as the teams from Latin America.

"It's going to be an especially challenging match. We played them last year in the Confederations Cup and after we played well for 35 minutes, they took over.

"But right now, we have to chase all negative thoughts away. We have to prepare from a mental and psychological point of view."