AMATRICE, Italy, Aug. 24 -- The death toll hit 159 in a major earthquake in central Italy as rescuers were working through night to search and dig out survivors on Wednesday.

At least 368 others were injured, said Italy's civil protection department, warning the number could climb further as some people are still unaccounted for.

The powerful 6.2 magnitude quake struck the mountainous area near the city of Rieti, some 140 km northeast of Rome, at 3:36 a.m. local time (0136 GMT) Wednesday, according to the National Institute of Volcanology and Seismology (INGV).

Amatrice and Accumoli, two small towns in Rieti province, were among the hardest hit.

In Amatrice, five bodies were pulled out from its famed Hotel Roma, with about 10 guests still missing, the rescuers said.

Local officials believed over 30 people were staying at the hotel when the earthquake hit.

At least 60 lives were claimed in Amatrice, civil protection chief Fabrizio Curcio told reporters while visiting the town.

At least another 20 people were killed in the villages of Arquata del Tronto and Pescara del Tronto in the eastern Marche region.

Rescue workers were digging with their bare hands in Amatrice to reach survivors trapped under the rubble. The voices of the survivors could still be heard hours after the major tremor had struck.

Most of the buildings along the two central streets collapsed with the quake, burying entire families who had come to spend their vacation in the area.

Amatrice is usually crowded with both local residents and holidaymakers in the summer time. Now most of it "was gone," mayor Sergio Pirozzi told local media, adding the death toll is expected to rise.

The local hospital was damaged and evacuated, but no severe injures were registered, the medical staff told Xinhua.

Only when buildings were so disintegrated there was no hope for survivors, did the rescuers work with bulldozers and heavy machinery to clear the rubble.

Otherwise, they dug in an eerie silence along the little roads in this medieval town in order not to miss possible signs of life.

Dozens of people, including children, were pulled out alive across the quake zone.

In Pescara del Tronto, a 10-year-old girl was rescued after some 17 hours under the rubble.

In Accumoli, very close to the epicenter, three-quarters of the buildings were destroyed and some 2,500 people evacuated, mayor Stefano Petrucci told local media.

The Italian army, police, plus dog units were added to civil protection officers and firefighters in a massive rescue operation. Tents were set up around villages and towns for thousands of homeless people.

Earlier in the day, Prime Minister Matteo Renzi, who visited the quake zone, pledged help and reconstruction efforts. The Italian cabinet will meet on Thursday to discuss measures to help the quake-hit regions.

The major quake was strongly felt all across the Lazio region, including in Rome, and as far as in Naples in the south and Bologna in the north, Ansa news agency reported.

The INGV said the epicenter was near Accumoli and Amatrice with a relatively shallow depth of four km below the surface. Some 150 aftershocks were registered in the 12 hours following the initial quake, it added.

The quake is being compared to the one that hit the city of L'Aquila in 2009, which killed over 300 people.

Wednesday's quake was "about two to three times smaller, in terms of energy released, to the one in L'Aquila," INGV seismologist Alessandro Amato told a press conference in Rome.